Form 140 Es - Individual Estimated Tax Payment - 2001
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1
22001
Individual Estimated Tax Payment
ARIZONA FORM
140ES
Mail to: Arizona Department of Revenue, PO Box 29085, Phoenix AZ 85038-9085
NOTE: To ensure proper application of this payment, this form must be completed in its entirety.
This estimated payment is for tax year ending December 31, 2001, or for tax year ending
Last name
Your First and Middle Initial
Your social security number
Spouse's social security number
Spouse's First and Middle Initial
Last name
Address - number and street, apt. no., rural route, post office box
ZIP code
City
State
DO NOT USE TO MAKE DELINQUENT INCOME TAX PAYMENT
For DOR use only
Select one:
This is a mandatory estimated tax payment
1
This is a voluntary estimated tax payment
2
The enclosed amount is payment for quarter number
Make Checks Payable To: Arizona Department of Revenue
Payment
ADOR 06-0016 (00)
You must round your estimated payment to a whole dollar (no cents).
Enclosed
Use this form only to make individual estimated tax payments. Do not use this form to make delinquent income tax payments.
2001
Individual Estimated Tax Payment
ARIZONA FORM
140ES
Mail to: Arizona Department of Revenue, PO Box 29085, Phoenix AZ 85038-9085
NOTE: To ensure proper application of this payment, this form must be completed in its entirety.
This estimated payment is for tax year ending December 31, 2001, or for tax year ending
Last name
Your First and Middle Initial
Your social security number
Spouse's social security number
Spouse's First and Middle Initial
Last name
Address - number and street, apt. no., rural route, post office box
ZIP code
City
State
DO NOT USE TO MAKE DELINQUENT INCOME TAX PAYMENT
For DOR use only
Select one:
This is a mandatory estimated tax payment
1
This is a voluntary estimated tax payment
2
The enclosed amount is payment for quarter number
Make Checks Payable To: Arizona Department of Revenue
Payment
ADOR 06-0016 (00)
You must round your estimated payment to a whole dollar (no cents).
Enclosed
Use this form only to make individual estimated tax payments. Do not use this form to make delinquent income tax payments.
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