Extension Payment Voucher - State Of Maine - 2001
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1*010093000*
STATE OF MAINE
EXTENSION PAYMENT VOUCHER
*010093000*
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Spouse’s Social Security number
Social Security number/EIN
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Name
Check the appropriate form:
a. 1040ME
(Individual) ........................
Spouse’s name (if applicable)
b. 1041ME
(Trust/Estate Income Tax) ..
c. 1120ME
Address
(C corp) .............................
d. 1120B-ME
(Financial Institutions) ......
City/Town
State
ZIP Code
e. 706ME ..............................
(Estate Tax)
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Contact person phone number:
Contact person name: ____________________________________
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Amount of Payment
,
,
.
Write your social security number/employer identification number on your check or money order.
Mail this voucher with payment to: Maine Revenue Services, P.O. Box 9114, Augusta, ME 04332-9114.
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GENERAL INFORMATION
CAUTION: AN EXTENSION TO FILE YOUR MAINE RETURN IS NOT AN EXTENSION FOR PAYMENT OF TAX.
If you will be filing an individual income tax return and you make a payment prior to the filing of that return, you must use
a Long Form (1040ME) when you file your return.
SPECIFIC INSTRUCTIONS
Lines 1 and 2.
Line 3.
Line 4.
Line 5. Payment amount.
INTEREST and PENALTIES
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