Form Ia 1040v - Individual Income Tax Payment Voucher
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1Iowa Individual Income Tax
Iowa Department of Revenue
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.
Instructions for Payment Vouchers
1.
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.
2. SSN: Enter the social security number in the boxes provided.
3. 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.
4. Enclose payment with your voucher – do not staple – complete using blue or black ink
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 1040V
Individual Income Tax Payment Voucher
Name:
Period Ending:
(Last, First, MI)
Address:
SSN:
City, State, ZIP:
Payment Amount:
Phone:
Mail to:
Make checks payable to:
Iowa Department of Revenue
Treasurer, State of Iowa
PO Box 9187
When you pay by check, you authorize the Department
*1441137019999*
Des Moines IA 50306-9187
of Revenue to convert your check to a one-time
electronic banking transaction.
41-137 (09/04/2014)
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