For/111040-V

For/111040-V Page 2 IF you live In ... THEN use this address to send in your payment ... Florida. Louisiana, Mississippi. Texas Internal Revenue Service P.O. Box 1214 Charlotte, NC 28201-1214 Alaska, Arizona, California, Colorado, Hawaii, Idaho, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming Internal Revenue Service P.O. Box 7704 San Francisco. CA 94120-7704 Arkansas, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota. Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, Wisconsin Internal Revenue Service P.O. Box 802501 Cincinnati. OH 45280-2501 Alabama. Georgia. Kentucky. New Jersey, North Carolina. South Carolina, Tennessee, Virginia Internal Revenue Service P.O. Box 931000 Louisville. KY 40293-1000 Delaware. Maine. Massachusetts. Missouri. New Hampshire. New York, Vermont Internal Revenue Service P.O. Box 37008 Hartford. CT 06176-7008 Connecticut. District of Columbia, Maryland. Pennsylvania, Rhode Island, West Virginia Internal Revenue Service P.O. Box 37910 Hartford. CT 06176-7910 A foreign country. American Samoa. or Puerto Rico (or are excluding income under Internal Revenue Code 933), or use an APO or FPO address, or tile Form 2555. 2555-EZ, or 4563, or are a dual-status alien or nonpermanent resident of Guam or the U.S. Virgin Islands. Internal Revenue Service P.O. Box 1303 Charlotte, NC 28201-1303 ♦ Detach Here and Mail With Your Payment and Return V 11040-V Pepsin (1. knemal %venueSe/VC* tgel Payment Voucher ► Do not staple or attach this voucher to your payment or return. 3 Amount you are paying by Cheek or money order. Make your check or money order payable to -United States Treasury" Dollars Cents EFTA01222572