PDF document

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2024 Remittance  

Voucher Specifications

Contents
2023 Changes   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 2 
Test Scenarios for Vouchers   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 3
Check Digit Formula and Name Control Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 4
Amount Paid Check Digit Formula Sample 1 and Sample 2  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 5
Fiduciary Income Tax Payment Voucher - Form MO-1041V  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  Page 6
Individual Income Tax Payment Voucher - Form MO-1040V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 7 
Estimated Tax Declaration For Individuals - Form MO-1040ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 8
Declaration of Estimated Tax For Corporation Income Tax - Form MO-1120ES . . . . . . . . . . . . . . . . . . . . .  .  Page 9
Corporation Income Tax Payment Voucher - Form MO-1120V  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 10
Employer’s Return of Income Taxes Withheld - Form MO-941  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  Page 11

                      (Revised 12-2023)

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Page 2
Most Missouri Department of Revenue vouchers are processed using automated processing equipment . The equipment
enables the Department to capture all data fields and thus process the vouchers more efficiently . Most vouchers have an
OCR scanline and are ICR compatible with dropout ink . All scanlines must use an OCR-A font . All scanline font is size 12,
with the exception of the MO-941 which contains the font size of 10 .5 . Please add your NACTP-assigned four digit vendor
ID to the voucher, near the revision date . Refer to each voucher type for more specific specifications regarding scanline and
variable data placement .

The Department requires 12 test samples (cut to size) with the appropriate scanline and all data fields filled (12 different
vouchers each for the MO-941, MO-1040V, MO-1041V, MO-1120V, MO-1120ES, and MO-1040ES) . The Department will
not accept text samples that are provided on full pages or remitted as an electronically PDF . Approval of each voucher type
must be obtained from the De part ment prior to filing .

Mail all test vouchers to: Missouri Department of Revenue
Attn: Communications - Forms Group
301 West High Street, Room 560
Jefferson City, MO 65101

2023 Changes

1 . The vouchers for Form MO-1040V, MO-1040ES, MO-1120ES, and MO-1120V are now set up to a 10x6 grid . Certain
field locations must match exactly to what is being provided in this document . In addition, the scanline must also match
exactly . The Department is providing examples of these vouches with the 10x6 grid showing in the back of this
document . Please use these as a reference when developing your substitute vouchers .

2 . Form MO-1040V - Be sure the Tax Year in the scanline is “23” . The year is updated to 2023 and the due date is April 15, 2024 .

3 . Form MO-1040ES - Be sure the Tax Year in the scanline is “24” . The year is updated to 2024 and the due dates are:
1st Quarter - April 15, 2024
2nd Quarter - June 17, 2024
3rd Quarter - September 16, 2024
4th Quarter - January 15, 2025 .

4 . Form MO-1041V - Be sure the Tax Year in the scanline is “23” . The year is updated to 2023 .

5 . Form MO-1120ES - Be sure the Tax Year in the scanline is “24” . The year is updated to 2024 .

6 . Form MO-1120V - Be sure the Tax Year in the scanline is “23” . The year is updated to 2023 and the due date is April 15, 2024 .

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                  Test Scenarios (MO-1120ES, MO-1120V, and MO-941)                 Page 3

Missouri Tax I.D. Name                   Address
98989898          TBone Corporation      123 Route C, Dinner City MO 65111 
78787874          Hi Kitty Inc           456 Route B, China City MO 65222 
65656563          Butterfly Company      789 Route D, Fun City MO 65333 
54545455          JDeere Corporation     147 Hwy RR, Anytown MO 69999 
32323239          Nite Owl Inc           258 Hwy YY, Anytown MO 69999 
56565658          Eastern Bluebird       369 Bird Lane, Birdtown MO 68888 
98765434          Flowering Dogwood      59 Tree Lane, Tree City MO 67777 
87654326          Lewis Clark Test Trail PO Box 1821, Discovery MO 65555 
76543218          Fox Trotter LLC        County RD 3652, Funtown MO 64444 
52525252          Waltz Thru MO          7854 Center Street, Music MO 63333 
85858587          Hawthorn Flower Inc    1452 Blooming Fields Rd, Ridge MO 62222  
96969696          Mark Twain Lodge       9856 Sunset Trails, Homestead MO 61111

                  Test Scenarios (MO-1040V, MO-1040ES, and MO-1041V)

SSN               Name                   Address
444444444         Payday River           PO Box 1720, Tears Valley MO 65555 
555555555         Weston Mill            5566 Hwy 65, Sugar Creek MO 64444 
666666666         Thomas Noster          7050 County Road, Big Hills MO 63333 
777777777         Bennett Truman         789 Center Road, Rock Stone MO 68888 
888888888         Hunter Boone           5461 Lake Branch Road, High Ridge MO 67777
222222222         Benny Loss             2713 Hwy 29, Traps MO 67888
333333333         Mikey Player           1713 County Road, Honey Hill MO 63333
212222222         Quite Mouse            258 Corner Street, Cheese Valley MO 64666
313333333         Donald Example         PO Box Sample, Test Again MO 65555
414444444         Night Owl              325 Upper Tree, Dark Town MO 68666
515555555         Rusty Lighting         Apt 23B, MyPlace MO 61666
616666666         Mickey Two             Waltz Street, Steer City MO 66366

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                                         Check Digit Formula and Name Control Number                                                                      Page 4

   Social Security Number (SSN) and Federal Employer                                            Name Control Number (NCN) Formula
         I.D. Number (FEIN) Check Digit Formula
                                                                                  The first four alpha characters of the taxpayer’s last name converted to 
The check digit validation process is:                                            numeric make up the NCN using the following formula . The NCN is an eight 
1 .  Multiply each of the digits in the SSN or FEIN by 2 or 1, beginning with 1 . digit number .
2 .  Add the sum of the products .
3 .  Divide the sum by 10 .                                                       A=01                   P=16
4 .  Subtract the remainder from 10 . The difference is the check digit .         B=02                   Q=17
                                                                                  C=03                   R=18
The following is an example of the validation process:                            D=04                   S=19
                                                                                  E=05                   T=20
SSN: 534209176                                                                    F=06                   U=21
                                                                                  G=07                   V=22
Multiply the SSN digits by 1, 2,  .  .  . (starting with the number 1)            H=08                   W=23
   5   3      4   2   0     9     1    7  6                                       I=09                   X=24
  X  1 2      1   2   1     2     1    2  1                                       J=10                   Y=25
   5   6      4   4   0     18    1    14 6                                       K=11                   Z=26
                                                                                  L=12                   , =27 (comma)
Sum the products:                                                                 M=13                   - =28 (hyphen) 
   5                                                                              N=14                   ‘ =29 (apostrophe) 
   6                                                                              O=15                    
   4                                                                               
   4                                                                              Examples:
   0                                                                                   Johnson = 10150814
   18                                                                                  LI,Adrian = 12092701 (Last name is less than 4 characters)
   1 
   6                                                                              After computing the NCN use the SSN Check Digit formula to compute the 
  + 14                                                                            NCN Check Digit .
   58
                                                                                  If the name is less than 4 characters long, use a comma, then the first 
Divide by 10:                                                                     charaters of the first name . (See example above .)
   58 ÷ 10 = 5 with remainder of 8
                                                                                  If one of the first four characters contain an apostrophe or hyphen use the 
Subtract the remainder from 10, the difference is the check digit .               codes specified above .
   10 – 8 = 2

The check digit is 2 .

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                                   Amount Paid Check Digit Formula Sample 1 and Sample 2                                                                   Page 5

                  Forms MO-1040V, MO-1040ES,                                                       Forms MO-1040V, MO-1040ES, 
              MO-1041V, MO-1120ES and MO-1120V                                                 MO-104I1V, MO-1120ES and MO-1120V

Amount Paid Check Digit Formula (Sample 1)                                        Amount Paid Check Digit Formula (Sample 2)

The check digit validation process is:                                            The check digit validation process is:

1 .  Multiply each of the digits in the Amount Paid by 2 or 1, beginning with 1 . 1 .  Multiply each of the digits in the Amount Paid by 2 or 1, beginning with 1 .
2 .  Add the sum of the products .                                                2 .  Add the sum of the digits .
3 .  Divide the sum by 10 .                                                       3 .  Divide the sum by 10 .
4 .  Subtract the remainder from 10 . The difference is the check digit .         4 .  Subtract the remainder from 10 . The difference is the check digit .

Following is an example of the validation process:                                Following is an example of the validation process:

Amount Paid: 134578900                                                            Amount Paid: 000594800

Multiply the Amount Paid digits by 1, 2,  .  .  .                                 Multiply the Amount Paid digits by 1, 2,  .  .  .
       1      3       4     5          7          8  9 0                  0             0      0        0         5     9          4 8               0     0
X 1           2       1     2          1          2  1 2                  1        X 1         2        1         2     1          2 1               2     1
       1      6       4     10         7          16 9 0                  0             0      0        0         10    9          8 8               0     0

Sum the products:                                                                 Sum the products:
1                                                                                  0
6                                                                                  0
4                                                                                  0
10                                                                                 10
7                                                                                  9
16                                                                                 8
9                                                                                  8
0                                                                                   +  0
  +  0                                                                             35
53
                                                                                  Divide by 10:
Divide by 10:                                                                           35 ÷ 10 = 3 with remainder of 5
  53 ÷ 10 = 5 with remainder of 3
                                                                                  Subtract the remainder from 10, the difference is the check digit .
Subtract the remainder from 10, the difference is the check digit .                     10 – 5 = 5
  10 – 3 = 7
                                                                                  The check digit is 5 .
The check digit is 7 .

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Fiduciary Income Tax Payment Voucher - Form MO-1041V Page 6

Form
MO-1041V 2023 Fiduciary Income Tax Payment Voucher

Federal Employer Identification Number Taxable Year Ending (MM/DD/YYYY) Due Date (MM/DD/YYYY)

Name of Estate or Trust
1 . Amount of
Name and Title of Fiduciary payment $ 3 0 0
(U .S . funds only)
Address
Department * •
Use Only
*
Return this form with check or money order payable to: Missouri
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any returned Department of Revenue, P .O . Box 3815, Jefferson City, MO
check may be presented again electronically. NNNN (12-2023) 65105-3815

103 098 000000 1234567890 100103118 202312 000000300 7

1 2 3 4 5 6 7 8 9 10

1 . Source Code (3 digits) 3 . DOR USE (6 zeros) 6 . Name Control(8 digits) 9 . Amount Paid (9 digit)
Use the digits “103” 4 . FEIN (9 digits) 7 . Check Digit (1 digit) Always ends with two zeros
2 . Vendor Code (3 digits) 5 . Check Digit (1 digit) 8 . Tax Period (6 digits) 10 . Check Digit (1 digit)
Use the assigned digits

Form Size: 8 1/2” x 3 3/4” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
Scanline Position: The bottom (baseline) of scanline should be placed 1/2” up from bottom of the form . The top of scanline should be 1/8” down from the last
horizontal line on the form . The scanline must be 1 7/8” from the right edge of form .
The scanline should be printed on Line 63 and Position 13 . (This is figured using 66 lines per page vertically and 85 characters printed horizontally . Our equipment
reads from the bottom right side of the paper .)
The scanline must be in OCR-A font .
Miscellaneous: “Amount of Payment” should have hard-coded zeros at the right . The zeros should be carried down to the scanline for “Amount Paid” which is
identified as item #9 in the scanline example above .
The “Department Use Only” area should have visible boxes . Eleven boxes on the top row and six boxes on the bottom row .
Provide the last three digits of your vendor ID code assigned to your company by NACTP within the scanline . This is identified as item #2 in the scanline example above .
This form is to be used to pay Fiduciary Income taxes for the previous tax year only .

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                                     Individual Income Tax Payment Voucher - Form MO-1040V                                                                                                                        Page 7

                                                                                                       Social Security
                             2023 Individual Income Tax                                                Number
                             Payment Voucher (Form MO-1040V)
                                                                                                       Name Control  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
               Please print. Make check payable to Missouri Department of Revenue. Mail Form           Spouse’s Social 
               MO-1040V and payment to the Missouri Department of Revenue, P.O. Box 371, 
               Jefferson City, MO 65105-0371.                                                          Security Number                               -  -
               Name 
                                                                                                       Spouse’s Name Control  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
               Spouse’s Name                                                                           Amount of Payment
                                                                                                       (U .S . funds only) . . . . . . . . . . . . . $  1234567                                              . 0 0
               Street Address
                                                                                                               *23347010001*
               City                                      State ZIP Code                                                  23347010001

               Full payment of taxes must be submitted by April 15, 2024 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 .
                                                                                                                                                        Form MO-1040V (Revised 12-2023)
                             055 000 000000 1234567890 123456789 1234567890 23 123456700 0

                             1       2            3      4     5                                       6     7         8 9                           10 11                                                12

1 .  Source Code (3 digits)  3 .  DOR USE (6 zeros)            6 .  Primary NCN (8 digits)                               9 .  Check Digit (1 digit)                                                       11 .   Amount Paid (9 digits)
  Use the digits “055”       4 .  Primary SSN (9 digits)       7 .  Check Digit (1 digit)                               10 .  Tax Year (YY) (2 digits)                                                          Always ends with two zeros 
2 . Vendor Code (3 digits)   5 .  Check Digit (1 digit)        8 .  Secondary SSN (9 digits)                               Should be “23” .                                                               12 .   Check Digit (1 digit)
  Use the assigned digits 

Form Size: 8 1/2” x 4” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
Scanline Position: The bottom (baseline) of the scanline should be placed 1/2” up from bottom of the form . The top of scanline should be 1/8” down from last  
horizontal line on the form . The scanline must be 1 1/4” from right edge of the form .
The scanline should be printed on Line 63 and Position 13 . (This is figured using 66 lines per page vertically and 85 characters printed horizontally . Our equipment 
reads from the bottom, right side of the paper .) 
The scanline must be in OCR-A font .
Miscellaneous: The “DOR USE ONLY” area should have visible boxes as shown in the example above . Provide the last three digits of your vendor ID code 
assigned to your company by NACTP within the scanline . This is identified as item #2 in the scanline example above .
This form is used only for electronic filing . It is not intended to be used to pay an amount due on a paper return .

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Estimated Tax Declaration For Individuals - Form MO-1040ES Page 8

2024 Declaration of Estimated Tax *24352010001*
for Individuals (Form MO-1040ES) 24352010001
Social Security Number Name Control
1st Qtr . 2nd Qtr . 3rd Qtr . 4th Qtr .
- -
Spouse’s Social Security Number Name Control
Amount Paid . . . . . . . . . .$ 1234567 . 0 0
- - Return this form with check or money order payable to the Missouri Department of
Revenue P .O . Box 555, Jefferson City, MO 65105-0555 . If you pay by check, you
Your Name (Last, First, Initial) authorize the Department to process the check electronically . Any returned check may
be presented again electronically .
Spouse’s Name (Last, First, Initial)
Department .
Address (Number and Street), City, State, and ZIP Code Use Only
(Revised 12-2023)

250 000 000000 1234567890 123456789 1234567890 24 123456700 0

1 2 3 4 5 6 7 8 9 10 11 12
1 . Source Code (3 digits) 3 . DOR USE (6 zeros) 6 . Primary NCN (8 digits) 9 . Check Digit (1 digit) 11 . Amount Paid (9 digits)
Use the digits “250” 4 . Primary SSN (9 digits) 7 . Check Digit (1 digit) 10 . Tax Year (YY) (2 digits) Always ends with two zeros
2 . Vendor Code (3 digits) 5 . Check Digit (1 digit) 8 . Secondary SSN (9 digits) Should be “24” . 12 . Check Digit (1 digit)
Use the assigned digits
Form Size: 8 1/2” x 3 3/4” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
Scanline Position: The bottom (baseline) of the scanline should be placed 1/2” up from bottom of the form . The top of scanline should be 3/16” down from last
horizontal line on the form . The scanline must be 1 1/4” from right side of page .
The scanline should be printed on Line 63 and Position 13 . (This is figured using 66 lines per page vertically and 85 characters printed horizontally . Our equipment
reads from the bottom right side of the paper .)
The scanline must be in OCR-A font .
Miscellaneous: “Amount of This Installment” should have hard-coded zeros at the right . The zeros should be carried down to the scanline for “Amount Paid”
which is identified as item #11 in the scanline example above .
The “Department Use Only” area should have visible boxes as shown in the example above .
Provide the last three digits of your vendor ID code assigned to your company by NACTP within the scanline . This is identified as item #2 in the scanline example above .
The Department does not want the address printed in the name and address area . Just print the names .
This form is to be used to pay Individual Estimated taxes for the current tax year only .

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Declaration of Estimated Tax For Corporation Income Tax - Form MO-1120ES Page 9

2024 Declaration Of Estimated Tax for *24119010001*
Corporation Income Tax (Form MO-1120ES) 24119010001
Missouri Tax I .D . Number Taxable Year Ending (MM/DD/YY)
1st Qtr . 2nd Qtr . 3rd Qtr . 4th Qtr .

Federal Employer I .D . Number Due Date (MM/DD/YY) Amount of this installment
(U.S. funds only).......... $ 123456789 . 00
Return this form with check or money order payable to the Missouri Department of Revenue
P .O . Box 3020, Jefferson City, MO 65105-3020 . If you pay by check, you authorize the
Business Name Department to process the check electronically . Any returned check may be presented again
electronically .
Address (Number and Street)
Department .
City, State, and ZIP Code Use Only
(Revised 12-2023)

023 000000 000 12345678 24 12345678900 1

1 2 3 4 5 6 7

1 . Sort Pattern (3 digits) 3 . Vendor Code (3 digits) 5 . Tax Year (YY) (2 digits) 6 . Amount of Installment (11 digit) 7 . Check Digit (1 digit)
Use the digits “023” Use the assigned digits) Should be “24” Always ends with two zeros
2 . DOR USE (6 zeros) 4 . MO I .D . Number (8 digit)

Note: First voucher will always be Quarter 1, second voucher will always be Quarter 2, third voucher will always be Quarter 3 and the fourth voucher will always be Quarter 4 .

Form Size: 8 1/2” x 3 3/4” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
Scanline Position: The scanline should be placed 1/2” up from the bottom of the form . The top of scanline should be 3/16” down from the last horizontal line on
the form . The scanline must be 1 1/2” from right side of page .
The scanline should be printed on Line 63 and Position 31 . (This is figured using 66 lines per page vertically and 85 characters printed horizontally . Our equipment
reads from the bottom, right side of the paper .)
The scanline must be in OCR-A font .
Miscellaneous: The “Amount of This Installment” should have hard-coded zeros at the right . The zeros should be carried down to the scanline for “Amount of
Installment” which is identified as item #8 on the scanline example above .
The “Department Use Only” area should have visible boxes as shown in the example above .
Provide the last three digits of your vendor ID code assigned to your company by NACTP within the scanline . This is identified as item #3 in the scanline example above .

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Corporation Income Tax Payment Voucher - Form MO-1120V Page 10

2023 Corporate Income Tax *23120010001*
Payment Voucher (Form MO-1120V) 23120010001

Missouri Tax I .D . Number Taxable Year Ending (MM/DD/YY)

000 087 000000 000000 000000 000000 0 12345678 23 12345678900 0

1 2 3 4 5 6 7 8 9 10 11

1 . Vendor Code (3 digits) 3 . DOR USE (6 zeros) 6 . DOR USE (6 zeros) 9 . Tax Year (YY) (2 digits) 10 . Amount of installment (9 digits)
Use the assigned digits 4 . DOR USE (6 zeros) 7 . Zero Should be “23” Always ends with two zeros
2 . Sort Pattern (3 digits) 5 . DOR USE (6 zeros) 8 . MO Tax I .D . Nmber (8 digits) 11 . Check Digit (1 digit)
Use the digits “087”

Form Size: 8 1/2” x 3 3/4” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
The scanline should be placed 1/2” up from the bottom of the form . The top of scanline should be 3/16” down from the last horizontal line on the form . The scanline
must be 1 1/4” from right side of page .
The scanline should be printed on Line 63 and Position 13 . (This is figured using 66 lines per page vertically and 85 characters printed horizontally .)
The scanline must be in OCR-A font .
Miscellaneous: The “Amount of This Installment” should have hard-coded zeros at the right . The zeros should be carried down to the scanline for the “Amount of
Installment” which is identified as item #10 in the scanline example above .
The “Department Use Only” area should have visible boxes as shown in the example above .
Provide the last three digits of your vendor ID code assigned to your company by NACTP within the scanline . This is identified as item #1 in the scanline example
above .

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                               Employer’s Return of Income Taxes Withheld - Form MO-941                                                                            Page 11

               Form                                                                             1 .  Withholding 
               MO-941
                           Employer’s Return of Income Taxes Withheld                             This Period  . . . . . . . . . . . . . . .  $               56900
                                                                                                2 .  Compensation 
          Filing Frequency                            Tax Period (MMYY)                          Deduction  . . . . . . . . . . . . . . . . .  $              600
                                                      0124                                      3 .  Previous Overpay 
          Missouri Tax Identification Number                                                      or Payments  . . . . . . . . . . . . .  $                   00
          12345678                                                                              4 .  Balance 
          Federal Employer Identification Number                                                 Due  . . . . . . . . . . . . . . . . . . . . . . . . . .  $  00
                                                                                                5 .  Additions To Tax 
          Name and Address of Employer                                                            (see instructions)  . . . . .  $                            00
                                                                                                6 .  Interest 
                                                                                                  (see instructions)  . . . . .  $                            00
          Under penalties of perjury, I declare  that the above information  and any attached   7 .  Total Amount Due 
          supplement is true, complete, and correct .                                             (U .S . funds only)  . . . . . .  $                         56300
          Authorized Signature                             Date (MM/DD/YYYY)
                                                                                               Department Use Only
          (NACTP Code)                                                                                                                                       *

                               000056300 000600 000056900 12345678202401

                                       1              2                 3                      4                 5    6

1 .  Line 7 - Total Amount Due 2 .  Line 2 - Compensation Deduction                           4 .  Missouri Tax Identification Number (8 digits)                   6 . Tax Month (2 digits)  
 (U .S . funds only)           3 .  Line 3 - Withholding This Period                          5 .  Tax Year (YYYY) (4 digits)
                                                                                                 Should be “2024”

Form Size: 7 3/8” x 3 9/16” . Vouchers must be printed and cut to this size for testing and for taxpayer filing .
The scanline should be placed 1/4” up from the bottom of the form . The top of scanline should be 3/16” down from the last horizontal line on the form . The 
 scanline must be 2 1/8” from right side of page .
The scanline should be printed on Line 20 and Position 13 . (This is figured using 10 lines per page vertically and 6 characters printed horizontally .)
The scanline must be in OCR-A font .
Miscellaneous: All financial amounts should have hard-coded zeros at the right . The zeros should be carried down to the scanline for items 1, 2, and 3 .
The “Department Use Only” area should have visible boxes . Eight boxes on the bottom row .
Provide all four digits of your vendor ID code assigned to your company by NACTP on this voucher . The code cannot be included within the 
scanline . It should appear below the “Authorized Signature” box .

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