Form 1040ext-Me - Extension Payment Voucher For Individual Income Tax - 2012

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Maine EZ Pay
You may pay your income tax electronically at Electronic payments eliminate
the necessity of fi ling forms 1040EXT-PV (extension payment voucher).
Maine EZ Pay is an online application that allows Maine taxpayers to make payments online, quickly and easily.
To avoid having to make payments earlier than necessary, payments may be scheduled in advance and will automatically
be withdrawn on the payment date the taxpayer selects.
Taxpayers must pre-register online with personal and bank account information, and payments will be withdrawn from
the checking or savings account that is set up in the registration. For more information, see
(click on Electronic Services).
To mail your payment, follow the instructions below.
DO NOT STAPLE OR TAPE CHECK TO YOUR FORM. DO NOT CUT OR DETACH THIS FORM. DO NOT SEND PHOTOCOPIES OF THIS FORM.
Enter your name(s), social security number(s), telephone number and address in the spaces provided. If you are fi ling
a joint return, enter your names and social security numbers in the same order as they appear on your return.
Enter the amount of your check or money order in the space provided.
Make checks payable to “Treasurer, State of Maine.”
Mail your completed payment voucher and payment to:
Maine Revenue Services
PO Box 9101
Augusta, ME 04332-9101
2012
Form 1040EXT-ME
99
Extension Payment Voucher
*1201600*
for Individual Income Tax
Your First Name
Initial
Your Social Security Number
Your Last Name
Spouse’s Social Security Number
Spouse’s First Name
Initial
Area Code
Home Phone Number
Spouse’s Last Name
Area Code
Work Phone Number
Address (number, street and apt. no.)
City/Town
State
Zip Code
Amount Paid with this voucher ..............................................
.00

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