Form Mo-1040es - Estimated Tax Declaration For Individuals - 2012

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2. First four letters
2012
1. Primary Social
*
*
of last name
MISSOURI DEPARTMENT OF REVENUE
Security Number ....
ESTIMATED TAX DECLARATION
FORM
MO‑1040ES
FOR INDIVIDUALS
3. Secondary Social
*
Security Number ....
YOUR NAME (LAST, FIRST, INITIAL)
4. Amount of this
0 0
$
Installment
SPOUSE’S NAME (LAST, FIRST, INITIAL)
(U.S. funds only) .....
IN CARE OF NAME
1st QTR
ADDRESS (NUMBER AND STREET)
*
(Calendar year—due
DOR USE ONLY
April 17, 2012)
CITY, STATE, ZIP CODE
*
If you pay by check, you authorize the Department of Revenue to process the check
electronically. Any check returned unpaid may be presented again electronically.
RETURN THIS FORM WITH CHECK OR MONEY ORDER PAYABLE TO:
MISSOURI DEPARTMENT OF REVENUE, P.O. BOX 555, JEFFERSON CITY,
IF YOU WISH TO RECEIVE A PREPRINTED COUPON BOOK FOR THE REMAINDER OF 2012, PLEASE CHECK THIS
*
MO 65105‑0555
BOX. (IT IS NOT NECESSARY TO CHECK THIS BOX FOR A 2013 BOOK, AS IT WILL BE AUTOMATICALLY ISSUED.)
(12-2011)
2. First four letters
2012
1. Primary Social
*
*
of last name
MISSOURI DEPARTMENT OF REVENUE
Security Number ....
ESTIMATED TAX DECLARATION
FORM
MO‑1040ES
FOR INDIVIDUALS
3. Secondary Social
Security Number ....
YOUR NAME (LAST, FIRST, INITIAL)
4. Amount of this
0 0
$
Installment
SPOUSE’S NAME (LAST, FIRST, INITIAL)
(U.S. funds only) ...
IN CARE OF NAME
2nd QTR
ADDRESS (NUMBER AND STREET)
*
(Calendar year—due
DOR USE ONLY
June 15, 2012)
CITY, STATE, ZIP CODE
.
*
If you pay by check, you authorize the Department of Revenue to process the check
electronically. Any check returned unpaid may be presented again electronically.
RETURN THIS FORM WITH CHECK OR MONEY ORDER PAYABLE TO:
MISSOURI DEPARTMENT OF REVENUE, P.O. BOX 555, JEFFERSON CITY,
IF YOU WISH TO RECEIVE A PREPRINTED COUPON BOOK FOR THE REMAINDER OF 2012, PLEASE CHECK THIS
*
MO 65105‑0555
BOX. (IT IS NOT NECESSARY TO CHECK THIS BOX FOR A 2013 BOOK, AS IT WILL BE AUTOMATICALLY ISSUED.)
(12-2011)
2. First four letters
2012
1. Primary Social
*
*
of last name
MISSOURI DEPARTMENT OF REVENUE
Security Number ....
ESTIMATED TAX DECLARATION
FORM
MO‑1040ES
FOR INDIVIDUALS
3. Secondary Social
*
Security Number ....
YOUR NAME (LAST, FIRST, INITIAL)
4. Amount of this
0 0
$
Installment
SPOUSE’S NAME (LAST, FIRST, INITIAL)
(U.S. funds only) ...
IN CARE OF NAME
3rd QTR
ADDRESS (NUMBER AND STREET)
*
(Calendar year—due
DOR USE ONLY
September 17, 2012)
CITY, STATE, ZIP CODE
*
If you pay by check, you authorize the Department of Revenue to process the check
electronically. Any check returned unpaid may be presented again electronically.
RETURN THIS FORM WITH CHECK OR MONEY ORDER PAYABLE TO:
MISSOURI DEPARTMENT OF REVENUE, P.O. BOX 555, JEFFERSON CITY,
MO 65105‑0555
(12-2011)

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