pdf2json/test/data/ia/form/ia_scr_1040v.content.txt

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Iowa Individual Income Tax Payment Voucher
www.iowa.gov/tax
Iowa Department of Revenue
Instructions
Individual Income Tax Payment Voucher
If payment is not made on or before April 30, 2013,
the tax due may be subject to penalty and interest.
If you owe additional tax,
send this voucher and your payment to:
Iowa Department of Revenue
Iowa Income Tax - Document Processing
PO Box 9187
Des Moines, Iowa  50306-9187
Mail to:
Iowa Income Tax
Iowa Department of Revenue
PO Box 9187
Des Moines, IA 50306-9187
ePay (direct debit) through eFile & Pay is FREE!
Instead of mailing a check, use ePay!
www.iowa.gov/tax
 Make check payable to
 
Treasurer - State of Iowa.
Enclose payment with your voucher - DO NOT STAPLE to the IA 1040V
           
 41-137  (10/17/12)
Iowa Department of Revenue
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
2012 IA 1040V
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.
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