Fillable Printable Form Mo-1041V - 2015 Fiduciary Income Tax Payment Voucher
Fillable Printable Form Mo-1041V - 2015 Fiduciary Income Tax Payment Voucher
Form Mo-1041V - 2015 Fiduciary Income Tax Payment Voucher
Form MO-1041V (Revised 12-2015)
The MO-1041V voucher is used if you have an amount
due on an electronically filed return, or you do not submit
payment in full when you file your Fidicuary Income Tax
Return (Form MO-1041). Your Fiduciary Income Tax
Return and payment are due no later than the 15th day
of the fourth month following the end of the income tax
year. When the due date falls on a Saturday, Sunday, or
legal holiday, the return and payment will be considered
timely if filed on the next business day. Do not use Form
MO-1041V for making extension payments, please use the
Application for Extension of Time to File (Form MO-60).
Complete the voucher in its entirety to ensure the payment
is applied to the correct account and tax period. On Line 1,
the payment must be entered in whole dollars and match
the amount of the check.
How do I make my payment?
• Attach a check or money order payable to the “Missouri
Department of Reve nue.” Do not send cash (U.S. funds
only). The Department of Revenue may collect checks
returned for insufficient or uncollected funds electronically.
• Write the name of the estate or trust, address, Federal
Employer Identification Number, daytime telephone
number, and “2015 MO Fiduciary Income Tax” on your
check or money order. Do not postdate your check; it
will be cashed upon receipt.
• Detach the payment voucher at the dotted line and
mail with your payment to the address listed on Form
MO-1041V.
Federal Privacy Notice
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 social security
numbers, and to explain why the information is needed and how the information will be used.
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 (c)(2)(C)
authorizes the states to require taxpayers to provide social security numbers.
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 you are complying with the tax laws, and to exchange tax information with the Internal Revenue Service, other states, and the Multistate Tax Commission (Chapters 32
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 financial
assistance under Chapter 173, RSMo and (2) to offset refunds against amounts 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 laws or the specific laws administered by the person having the statutory right to obtain it [as
indicated above]. In addition, information may be disclosed to the public regarding the 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 numbers, see Chapters 135, 143, and 144, RSMo.)
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 in criminal action against
you.
1 2 3 4 5 6 7 8 9 0
Please print as shown below in
black or dark blue ink.
*
•
*
Department Use Only
Federal Employer Identification Number Taxable Year Ending (MM/DD/YYYY) Due Date (MM/DD/YYYY)
Name of Estate or Trust
Name and Title of Fiduciary
Address
City State Zip Code
Full payment of taxes must be submitted by April 18, 2016 to avoid interest and addition 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 again electronically.
1. Amount of payment
(U.S. funds only) ...............
$
•
00
__ __ /__ __ /__ __ __ __
__ __ /__ __ /__ __ __ __
Form
MO-1041V
Missouri Department of Revenue
2015 Fiduciary Income Tax Payment Voucher
Mail to: Taxation Division Phone: (573) 751-3505
P.O. Box 3815 Fax: (573) 526-7939
Visit http://dor.mo.gov/personal/fiduciary/
for additional information.
Form
MO-1041V
Missouri Department of Revenue
2015 Fiduciary Income Tax Payment Voucher
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