Form Ia 1040xv - Amended Income Tax Payment Voucher
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1Iowa Department of Revenue
Iowa Amended Individual Income Tax
Payment Voucher and Instructions
ePay (direct debit) through eFile & Pay is FREE!
If you are amending a current year tax return,
use ePay instead of mailing a check!
If you owe additional tax,
send this voucher and your payment to:
Iowa Department of Revenue
Iowa Income Tax - Document Processing
PO Box 10466
Des Moines, Iowa 50306-0466
Make check payable to Treasurer - State of Iowa.
Enclose payment with your voucher - DO NOT STAPLE to the IA 1040XV
If the amended payment is for the current tax year,
and payment is made after April 30,
the tax due may be subject to penalty and interest.
Amended payments for prior tax years
may also be subject to penalty and interest.
Iowa Department of Revenue
IA 1040XV
Amended Income Tax Payment Voucher
Mail to:
Iowa Income Tax
Iowa Department of Revenue
PO Box 9187
Des Moines, IA 50306-9187
FOR TAX YEAR ______________
PRINT name (last, first, middle initial)
Social Security Number
Spouse's name (last, first, middle initial)
Spouse's Social Security Number
Address (number and street, including apartment)
Payment Amount
City, State, ZIP
Daytime Telephone Number
(
)
-
*1241121019999*
Make check payable to: Treasurer - State of Iowa
When you pay by check, you authorize the Department of Revenue to convert
your check to a one-time electronic banking transaction.
41-121 (10/17/12)
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