Form Mo-1040v - Individual Income Tax Payment Voucher - 2016
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1MISSOURI DEPARTMENT OF REVENUE
INDIVIDUAL INCOME TAX PAYMENT VOUCHER INSTRUCTIONS
What Is Form MO-1040V and Why Should I Use It?
How Do I Make My Payment?
Form MO-1040V, Individual Income Tax Payment Voucher, is
• Make your check or money order payable to the “Missouri
the voucher you send with your payment when you do not make
Department of Reve nue.” Do not send cash (U.S. funds only).
the payment with your income tax return. It is similar to
Do not postdate your check; it will be cashed upon receipt. The
vouchers returned with loan, utility, and credit card payments.
Department of Revenue may collect checks returned for insufficient
Form MO-1040V ensures that your payment will be processed
or uncollected funds electronically.
more efficiently and accurately. Form MO-1040V allows you to
• Write your name, address, SSN, daytime telephone number, and
file your completed income tax return and send your payment at
“2016 MO Income Tax” on your check or money order.
a later date. Your income tax return and payment are due no
• Detach the payment voucher at the perforation, and mail with your
later than April 18, 2017.
payment.
When Should I Use Form MO-1040V?
• Please mail your Form MO-1040V and payment to:
If you have an amount due on an electronically filed return, or do not
Missouri Department of Revenue
submit payment in full when you file your income tax return, send
P.O. Box 371
Form MO-1040V with your payment. DO NOT use Form MO-1040V
Jefferson City, MO 65105-0371
for making extension payments. Please use Form MO-60, or visit
Please print as shown below in black or dark blue ink. Do not
our website to pay online.
use red ink or pencil.
1 2 3 4
A B C D
How Do I Fill In the Payment Voucher?
Complete the name(s) and address block.
Federal Privacy Notice
Line 1 - Enter your social security number (SSN) on Line 1. If you
are filing a combined return, enter on Line 1 the first SSN as shown
The Federal Privacy Act requires the Missouri Department of Revenue (Department) to inform
taxpayers of the Department’s legal authority for requesting identifying information, including
on your return.
social security numbers, and to explain why the information is needed and how the information
will be used.
Line 2 - Enter the first four letters of your last name on Line 2.
Chapter 143 of the Missouri Revised Statutes authorizes the Department to request information
See examples.
necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section 405
NAME
ENTER
(c)(2)(C) authorizes the states to require taxpayers to provide social security numbers.
John Brown
BROW
The Department uses your social security number to identify you and process your tax
}
returns and other documents, to determine and collect the correct amount of tax, to ensure
Juan De Jesus
DEJE
you are complying with the tax laws, and to exchange tax information with the
Joan A. Lee
LEE
Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32
Please use capital
and 143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide
Jean McCarthy
MCCA
letters as shown.
information to the Department of Higher Education with respect to applicants for
John O’Neill
ONEI
financial assistance under Chapter 173, RSMo and (2) to offset refunds against amounts
due to a state agency by a person or entity (Chapter 143, RSMo). Information furnished
Pedro Torres-Lopez
TORR
to other agencies or persons shall be used solely for the purpose of administering tax
Line 3 - If you are filing a combined return, enter on Line 3 your
laws or the specific laws administered by the person having the statutory right to obtain it
[as indicated above]. In addition, information may be disclosed to the public regarding the
spouse’s SSN.
name of a tax credit recipient and the amount issued to such recipient (Chapter 135, RSMo).
(For the Department’s authority to prescribe forms and to require furnishing of social security
Line 4 - Enter the first four letters of your spouse’s last name on Line
numbers, see Chapters 135, 143, and 144, RSMo.)
4. See examples for Line 2, above.
You are required to provide your social security number on your tax return. Failure to
Line 5 - Enter the amount of your payment in whole dollars on Line 5.
provide your social security number or providing a false social security number may result
in criminal action against you.
Reset Form
Print Form
1. Social
2016
*
security number ..........
INDIVIDUAL INCOME TAX
FORM
2. Name
MO-1040V
*
PAYMENT VOUCHER
control ........................
3. Spouse’s social
PLEASE PRINT. MAKE CHECK PAYABLE TO MISSOURI DEPARTMENT OF
*
REVENUE. MAIL FORM MO-1040V AND PAYMENT TO THE MISSOURI
security number ..........
DEPARTMENT OF REVENUE, P.O. BOX 371, JEFFERSON CITY, MO 65105-0371.
4. Spouse’s name
NAME
*
control .......................
5. Amount of payment
0 0
$
SPOUSE’S NAME
•
(U.S. funds only) ........
STREET ADDRESS
Do not mail a copy of your previously filed return
CITY
STATE
ZIP CODE
FULL PAYMENT OF TAXES MUST BE SUBMITTED BY April 18, 2017 TO AVOID
*
INTEREST AND ADDITION TO TAX FOR FAILURE TO PAY. If you pay by check,
•
you authorize the Department of Revenue to process the check electronically. Any
DOR USE ONLY
returned check may be presented again electronically.
*
• PLEASE SEND CHECK OR MONEY ORDER (U.S. FUNDS ONLY)
Form MO-1040V (Revised 12-2016)
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