Form 1040-Es (Nr) - Estimated Tax Payment Voucher - 2012 Page 9
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93
1040-ES (NR)
2012
Estimated Tax
Department of the Treasury
Payment Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due Sept. 17, 2012
File only if you are making a payment of estimated tax by check or money order. Return this
Amount of estimated tax you are
voucher with your check or money order payable to the “United States Treasury.” Write your
paying by
identifying number and “2012 Form 1040-ES (NR)” on your check or money order. Do not send
Dollars
Cents
check or
cash. Enclose, but do not staple or attach, your payment with this voucher.
money order.
Your identifying number (SSN or ITIN) (employer identification number for an estate or trust)
Your first name and initial
Your last name
Address (number, street, and apt. no.)
City, state, and ZIP code. If a foreign address, enter city, province or state, and country. Include postal code.
For Privacy Act and Paperwork Reduction Act Notice, see page 7.
Tear off here
2
1040-ES (NR)
2012
Estimated Tax
Department of the Treasury
Payment Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due June 15, 2012
File only if you are making a payment of estimated tax by check or money order. Return this
Amount of estimated tax you are
voucher with your check or money order payable to the “United States Treasury.” Write your
paying by
identifying number and “2012 Form 1040-ES (NR)” on your check or money order. Do not send
Dollars
Cents
check or
cash. Enclose, but do not staple or attach, your payment with this voucher.
money order.
Your identifying number (SSN or ITIN) (employer identification number for an estate or trust)
Your first name and initial
Your last name
Address (number, street, and apt. no.)
City, state, and ZIP code. If a foreign address, enter city, province or state, and country. Include postal code.
For Privacy Act and Paperwork Reduction Act Notice, see page 7.
Tear off here
1
1040-ES (NR)
2012
Estimated Tax
Department of the Treasury
Payment Voucher
OMB No. 1545-0074
Internal Revenue Service
Calendar year—Due April 17, 2012
File only if you are making a payment of estimated tax by check or money order. Return this
Amount of estimated tax you are
voucher with your check or money order payable to the “United States Treasury.” Write your
paying by
identifying number and “2012 Form 1040-ES (NR)” on your check or money order. Do not send
Dollars
Cents
check or
cash. Enclose, but do not staple or attach, your payment with this voucher.
money order.
Your identifying number (SSN or ITIN) (employer identification number for an estate or trust)
Your first name and initial
Your last name
Address (number, street, and apt. no.)
City, state, and ZIP code. If a foreign address, enter city, province or state, and country. Include postal code.
For Privacy Act and Paperwork Reduction Act Notice, see page 7.
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