Form Pa-V - Pa Payment Voucher - 2014

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BUREAU OF INDIVIDUAL TAXES
PO BOX 280600
HARRISBURG, PA 17128-0600
PA-40 Payment Voucher (PA-V)
Use the 2014 form PA-V with your payment if you owe tax with your 2014 PA-40, Individual Income Tax Return. Do not use this
voucher for any other purpose. Follow the instructions below.
Social Security Number (SSN)
● SSN - enter your nine-digit SSN without the hyphens.
● SSN - enter your spouse’s nine-digit SSN without the hyphens.
Check Digit
Print the first two letters of the last name of the taxpayer.
Name of Taxpayer and Spouse
● Print the last name, first name and middle initial of the taxpayer and spouse.
Address
● First and Second Line of Address – Print the taxpayer’s complete street address. If the address has an apartment, suite or
RR number, enter after the street address. If only one line is needed, use the First Line of Address.
● City – Print the name of the city. For foreign addresses, the bottom line of the address should show only the country name,
written in full (no abbreviations) and in capital letters.
● State – Print the two-digit state abbreviation.
● ZIP – Print the five-digit ZIP Code.
Taxpayer’s Phone Number
Print the taxpayer’s 10-digit phone number with area code including hyphens.
Payment
Carefully enter the amount of your payment.
Make the check or money order payable to the PA DEPT. OF REVENUE. Please write on your check or money order:
● The last four digits of the primary taxpayer’s SSN;
● "2014 PA-40"; and
● Daytime telephone number of the taxpayer(s).
If the check or money order does not include the primary taxpayer’s name, the department will also need the name of the primary
taxpayer as well as the information requested above. In the event the check becomes separated from the PA-V, the department
will need this information to accurately apply the payment.
Mailing Address
If you are filing a paper return, please remit payment with your return.
If you are filing using Fed/State e-file, PA Free File or PA Free Fillable Forms please use the following address:
PA DEPARTMENT OF REVENUE
PAYMENT ENCLOSED
1 REVENUE PLACE
HARRISBURG PA 17129-0001
t
t
DETACH HERE
2014 PA-V
PA PAYMENT VOUCHER
PRIMARY SSN
CHECK DIGIT
SPOUSE’S SSN
START
PAYMENT AMOUNT
LAST NAME
FIRST NAME
MI
SPOUSE’S LAST NAME
FIRST NAME
MI
FIRST LINE OF ADDRESS
SECOND LINE OF ADDRESS
CITY
STATE
ZIP
PHONE NUMBER
Make check or money order
payable to the Pennsylvania
Department of Revenue
DEPARTMENT USE ONLY
PRINT FORM
Reset Entire Form

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