Form Ia 1040xv - Amended Individual Income Tax Payment Voucher
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1Iowa Department of Revenue
Iowa Amended Individual Income Tax
Payment Voucher and Instructions
Pay electronically using eFile & Pay on the Department's website:
Note: Penalties can only be waived under limited circumstances, as described in Iowa Code section
421.27.
Failure to Timely File a Return: A penalty of 10% will be added to the tax due for failure to
timely file a return if the return is filed after the original due date of the return and if at least 90%
of the correct amount of tax is not paid by the original due date of the return.
Failure to Timely Pay the Tax Due or Penalty for Audit Deficiency: A penalty of 5% will be
added to the tax due if the return is filed by the original due date and at least 90% of the correct
amount of tax is not paid by the original due date of the return.
When the failure to file penalty and the failure to pay penalty are both applicable, only the failure
to file penalty will apply.
Penalty for Willful Failure to File: A penalty of 75% will be added to the tax due for willful
failure to file a return or for filing with intent to evade tax.
If the amended payment is for the current tax year and payment is made after April 30, the tax due
may be subject to penalty and interest. Additionally, amended payments for prior tax years may also
be subject to penalty and interest.
Instructions for Payment Vouchers
1. Enclose payment with your voucher – do not staple – complete using blue or black ink
2.
Period Ending: Enter the date of the calendar or fiscal year end. Use MMDDYY format. MM: two-
digit month. DD: two-digit day. YY: last two digits of the tax year. The “Period Ending” for
December 31, 2014, would be entered as: 123114.
3. SSN: Enter your social security number in the boxes provided below.
4. Payment Amount: Enter dollars and cents. The two boxes separated to the right on the “Payment
Amount” line are for cents. Do not enter any punctuation (ex: $, .).
Enter the amount of the
check/money order you are sending with this payment voucher.
5. Mail your payment on or before the due date with this voucher to:
Iowa Department of Revenue
PO Box 9187
Des Moines IA 50306-9187
Iowa Department of Revenue
IA 1040XV
Amended Individual Income
Tax Payment Voucher
Name:
(Last, First, MI)
Address:
Period Ending:
City, State, ZIP:
SSN:
Phone:
Payment Amount:
Mail to:
Make checks payable to:
Iowa Department of Revenue
Treasurer, State of Iowa
When you pay
PO Box 9187
by check, you authorize the Department of
*1441121019999*
Des Moines IA 50306-9187
Revenue to convert your check to a one-time
electronic banking transaction.
41-121 (09/25/2014)
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