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Ever served on active duty in the United States Armed Forces?
Form If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all
MO-1040V 2022 Individual Income Tax Payment Voucher eligible military individuals. A list of all state agency resources and benefits can
be found at veteranbenefits.mo.gov/state-benefits/.
What Is Form MO-1040V and Why Should I Use It? How Do I Make My Payment?
Form MO-1040V, Individual Income Tax Payment Voucher, is the • Make your check or money order payable to the “Missouri
voucher you send with your payment when you do not make the Department of Reve nue.” Do not send cash. Do not postdate your
payment with your income tax return. It is similar to vouchers returned check; it will be cashed upon receipt. The Department of Revenue
with loan, utility, and credit card payments. Form MO-1040V ensures may collect on checks returned for insufficient or uncollected funds
that your payment will be processed more efficiently and accurately. electronically. (U.S. funds only)
Form MO-1040V allows you to file your completed income tax return • Write your name, address, SSN, daytime telephone number, and
and send your payment at a later date. Your income tax return and “2022 MO Income Tax” on your check or money order.
payment are due no later than April 18, 2023. • Detach the payment voucher at the perforation, and mail with your
When Should I Use Form MO-1040V? payment. Do not mail a copy of your previously filed return.
If you have an amount due on an electronically filed return, or do not • Please mail your Form MO-1040V and payment to:
submit payment in full when you file your income tax return, send Missouri Department of Revenue
Form MO-1040V with your payment. DO NOT use Form MO-1040V P.O. Box 371
for making extension payments. Please use Form MO-60 or visit our Jefferson City, MO 65105-0371
website to pay online. Please print as shown below in black or dark blue ink. Do not use
How Do I Fill In the Payment Voucher? red ink or pencil.
Complete the name(s) and address block. 1 2 3 4 A B C D
• Social Security Number - Enter your social security number (SSN).
If you are filing a combined return, enter your and your spouse’s Federal Privacy Notice
SSN(s) in the order they appear on the return; placing your The Federal Privacy Act requires the Missouri Department of Revenue (Department) to inform
taxpayers of the Department’s legal authority for requesting identifying information, including
spouse’s SSN in the appropriate field below. social security numbers, and to explain why the information is needed and how the information
• Name Control - Enter the first four letters of your last name. will be used.
See examples. If you are filing a combined return, enter your Chapter 143 of the Missouri Revised Statutes authorizes the Department to request information
necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section 405
and your spouse’s name control in the order they appear on the (c)(2)(C) authorizes the states to require taxpayers to provide social security numbers.
return, placing your spouse’s name control in the appropriate The Department uses your social security number to identify you and process your tax
returns and other documents, to determine and collect the correct amount of tax, to ensure
field below. you are complying with the tax laws, and to exchange tax information with the
Name Enter Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32
John Brown BROW and 143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide
information to the Department of Higher Education with respect to applicants for
Juan De Jesus DEJE financial assistance under Chapter 173, RSMo and (2) to offset refunds against amounts
Joan A. Lee LEE Please use capital due to a state agency by a person or entity (Chapter 143, RSMo). Information furnished
to other agencies or persons shall be used solely for the purpose of administering tax
Jean McCarthy MCCA letters as shown. laws or the specific laws administered by the person having the statutory right to obtain it
John O’Neill ONEI [as indicated above]. In addition, information may be disclosed to the public regarding the
Pedro Torres-Lopez TORR } name of a tax credit recipient and the amount issued to such recipient (Chapter 135, RSMo).
(For the Department’s authority to prescribe forms and to require furnishing of social security
• Amount of Payment - Enter the amount of your payment in whole numbers, see Chapters 135, 143, and 144, RSMo.)
dollars. You are required to provide your social security number on your tax return. Failure to
provide your social security number or providing a false social security number may result
Reset Form Print Form in criminal action against you.
Social Security
2022 Individual Income Tax Number - -
Payment Voucher (Form MO-1040V)
Name Control ..................................
Please print. Make check payable to Missouri Department of Revenue. Mail Form
MO-1040V and payment to the Missouri Department of Revenue, P.O. Box 371, Spouse’s Social
Jefferson City, MO 65105-0371. Security Number - -
Name
Spouse’s Name Control . . . . . . . . . . . . . . . . . . . . . . . . . .
Spouse’s Name Amount of Payment
(U.S. funds only)............. $ .
Street Address
*22347010001*
City State ZIP Code 22347010001
Full payment of taxes must be submitted by April 18, 2023 to avoid interest and Department Use Only .
additions to tax for failure to pay. If you pay by check, you authorize the Department
of Revenue to process the check electronically. Any returned check may be presented Department Use Only
again electronically.
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