Occupational Tax and Registration Return for Wagering

f
o
s
a
8
t
0
f
0
a
2
r
/
D /19
2
0

Form 11-C(V),
Payment Voucher
Purpose of Form

Complete Form 11-C(V), Payment Voucher, and file it
with Form 11-C, Occupational Tax and Registration
Return for Wagering. We will use Form 11-C(V) to
credit your payment more promptly and accurately,
and to improve our service to you.
If you have your return prepared by a third party,
provide Form 11-C(V) to the return preparer.

Specific Instructions

Box 1. If you do not have an EIN, apply for one online.
Go to the IRS website at www.irs.gov/businesses/small
and click on the “Employer ID Numbers” link. You may
also apply for an EIN by calling 1-800-829-4933, or
you can fax or mail Form SS-4, Application for
Employer Identification Number, to the IRS.

Form

䊲

Box 2. Enter the amount paid with Form 11-C.
Box 3. Enter the same year and month you entered on
the “Return for period from” line at the top of Form
11-C. For example, if your return is for the full period
that begins July 1, 2008, enter 200807.
Box 4. Enter your name and address as shown on
Form 11-C.
● Enclose your check or money order made payable to
the “United States Treasury.” Be sure to enter your
EIN, “Form 11-C,” and the tax period on your check or
money order. Do not send cash. Do not staple
Form 11-C(V) or your payment to Form 11-C (or to
each other).
● Detach Form 11-C(V) and send it with your payment
3.
and Form 11-C. See Where to file on page 2.

Detach Here and Mail With Your Payment and Form 11-C.

11-C(V)

䊲

Payment Voucher

(Rev. April 2008)

OMB No. 1545-0235

Department of the Treasury
Internal Revenue Service

䊳

Do not staple or attach this voucher to your payment or Form 11-C.

1 Enter your employer identification
number.

3

Enter the amount of your payment.

Y

Y

Y

M

M
Enter your address.

Send Form 11-C, this voucher, and payment to:
Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0101

䊳

4 Enter your business name (individual name if sole proprietor).

Enter year and month as shown on Form 11-C.

Y

Dollars

2

Enter your city, state, and ZIP code.

Cents