Fillable Form N-200v - Individual Income Tax Payment Voucher

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FORM

STATE OF HAWAII –– DEPARTMENT OF TAXATION

N-200V

INDIVIDUAL INCOME TAX PAYMENT VOUCHER

2012

(Rev. 2012)

(NOTE: References to “married”, “unmarried”, and “spouse” also means

“in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)

GENERAL INSTRUCTIONS

INTERNET FILING — Form N-200V can be filed and

spouse’s name and social security number in the space

payment made electronically through the State’s Internet

provided.

portal. For more information, go to

If you have a foreign address, enter the complete country

name in the space provided.

ABOUT THIS FORM

The Form N-200V has been redesigned for electronic

If you are an alien and were issued an individual taxpayer

scanning that permits faster processing with fewer errors.

identification number (ITIN) by the IRS, enter your ITIN. If

In order to avoid unnecessary delays caused by manual

you applied for an ITIN but the IRS has not yet issued the

processing, taxpayers should follow the guidelines listed

ITIN, write “ITIN Applied For” in the space above the box

below:

where you enter your name.

1. Print amounts only on those lines that are applicable.

Print the amount of your payment in the space provided.

2. Use only a black or dark blue ink pen. Do not use red ink,

Make your check or money order payable in U.S. dollars to

pencil, or felt tip pens.

“Hawaii State Tax Collector”. Make sure your name and

3. Because this form is read by a machine, please print your

address appear on your check or money order. Please write

numbers inside the boxes like this:

your social security number, daytime phone number, and

1 2 3 4 5 6 7 8 . 9 0

“2012” along with the form number of the tax return you are

filing (e.g. “2012 Form N-11”). Do not postdate your check.

4. Do NOT print outside the boxes.

Do not send cash.

5. Do NOT use dollar signs, commas, slashes, dashes or

WHERE TO FILE

parenthesis in the boxes.

6. Photocopying of this form could cause delays in processing

Detach Form N-200V along the dotted line. Attach your

your payment.

payment and Form N-200V to the front of your return and

send to:

PURPOSE OF FORM

Hawaii Department of Taxation

If you have a balance due on your 2012 Form N-11, N-13,

Attn: Payment Section

N-15, or N-310, use Form N-200V to send your payment to

P. O. Box 1530

the Department of Taxation. Using Form N-200V allows us to

Honolulu, Hawaii 96806-1530

process your payment more accurately and efficiently.

HOW TO COMPLETE FORM

Note: If you filed electronically, but are not paying

electronically, attach your check or money order to the front

Print your name, address, and social security number in

of Form N-200V and send them to the above mailing address.

the space provided. If you are filing a joint return, print your



DETACH HERE

Form

Tax Year

(Rev. 2012)

STATE OF HAWAII — DEPARTMENT OF TAXATION

DO NOT WRITE OR STAPLE IN THIS SPACE

N-200V

2012

INDIVIDUAL INCOME TAX PAYMENT VOUCHER

DO NOT SUBMIT A PHOTOCOPY OF THIS FORM

JHF121

Your first name

M.I.

Last name

If joint return, spouse’s first name

M.I.

Last name

Your Social Security Number

Present mailing or home address (Number and street, including rural route)

Apartment Number

Spouse’s Social Security Number

City, town, or post office

State

Postal/ZIP Code

Country

For office use only

Amount of Payment

MAIL THIS VOUCHER WITH CHECK OR MONEY ORDER PAYABLE TO

“HAWAII STATE TAX COLLECTOR.” Write your social security number,

daytime phone number, “2012”, and form number of the tax return you

ID NO 01

are filing (e.g. “2012 Form N-11”) on your check or money order.

Form N-200v - Individual Income Tax Payment Voucher - 2012

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