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Declaration Control Number (DCN) 4 00 EPV ARIZONA FORM Arizona Individual Income Tax AZ-140V 1000 SYS 0184 2003 Payment Voucher for Electronic Filing 218 40 1 Your social security number 2 Spouse’s social security number 3 Amount of payment $ 4 Your first name Spouse’s first name Last name POSTMARK Please Print or Type Present home address - number and street, rural route City, town or post office State Zip code Do not send cash. Check or money order is to be made payable to the NOTE: To avoid interest and penalties you must pay the full amount of your Arizona Department of Revenue. Include your social security number tax by April 15, 2004. You will not receive an additional notice from the and “2003 Tax” on the check or money order. Attach your payment Arizona Department of Revenue unless an error exists with your return. to this form and mail both to: Arizona Department of Revenue, PO Box 29237, Phoenix AZ 85038-9237 ADOR 91-0016 (03)

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  • 1. Declaration Control Number (DCN) 4 00 EPV ARIZONA FORM Arizona Individual Income Tax AZ-140V 1000 SYS 0184 2003 Payment Voucher for Electronic Filing 218 40 1 Your social security number 2 Spouse’s social security number 3 Amount of payment $ 4 Your first name Spouse’s first name Last name POSTMARK Please Print or Type Present home address - number and street, rural route City, town or post office State Zip code Do not send cash. Check or money order is to be made payable to the NOTE: To avoid interest and penalties you must pay the full amount of your Arizona Department of Revenue. Include your social security number tax by April 15, 2004. You will not receive an additional notice from the and “2003 Tax” on the check or money order. Attach your payment Arizona Department of Revenue unless an error exists with your return. to this form and mail both to: Arizona Department of Revenue, PO Box 29237, Phoenix AZ 85038-9237 ADOR 91-0016 (03)