Form F-1040pv - Income Tax Return Payment Voucher - City Of Flint - 2016
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1FLINT
F-1040PV
2016 RET RPV
INCOME TAX RETURN PAYMENT VOUCHER
Taxpayer Name:
Social Security No:
4/30/2017 due date of 2016 return
Due on or Before:
$
Payment:
Make payment by check or money order payable to "City of Flint." Include your social security number,
Payment Method:
daytime phone number, and "2016 F-1040PV" on your check or money order. DO NOT SEND CASH.
Paying with Return:
This payment voucher is not used when including payment with your tax return. When paying with your
return, place the payment on top of the return in the envelope. Do not attach the check to the return.
City of Flint Income Tax Dept
Address for Payment:
PO Box 529
Eaton Rapids, MI 48827
Taxpayer Records:
Amount Paid:
Check Number:
Date Mailed:
KEEP TOP PORTION FOR YOUR RECORDS. SEND BOTTOM PORTION WITH YOUR PAYMENT
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DETACH HERE
FLINT
F-1040PV
Mail To: City of Flint Income Tax Dept, PO Box 529, Eaton Rapids, MI 48827
2016 RET RPV
INCOME TAX RETURN PAYMENT VOUCHER
NACTP #
EFIN #
Taxpayer's first name, initial, last name
Taxpayer's SSN
If joint return spouse's first name, initial, last name
If joint payment, spouse's SSN
Present home address (Number and street)
Apt. no.
Address line 2 (P.O. Box address for mailing use only)
City, town or post office
State
Zip code
Foreign country name, province/county, postal code
Round to nearest dollar
Amount of tax, interest and penalty you are paying by
check or money order
.00
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