Form Il-1040-X-V - Illinois Payment Voucher For Amended Individual Income Tax - 2015

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Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
If no payment is due, do not file this form.
We encourage you to pay electronically using MyTax Illinois. If you make your payment
electronically do not file this form.
If you do not elect to pay electronically, pay the amount you owe on your Form IL-1040-X,
Amended Individual Income Tax Return, using the IL-1040-X-V at the bottom of this page.
Complete the IL-1040-X-V below and send it, along with your payment, to the address on
the voucher.
Illinois Department of Revenue
2015 IL-1040-X-V
Reset
Print
Payment Voucher for Amended Individual Income Tax
(R-12/15)
.
Your Social Security number
Spouse’s Social Security number
$
Payment amount
Make your check payable to and mail to
Your first name and initial
Spouse’s first name and initial
Your last name
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19007
SPRINGFIELD IL 62794-9007
Street address
Write your Social Security number(s) on your check.
*IL-1040-X-V*
City
State
ZIP

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