EFTA01222572

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