*1109600*
1041ME EXT for FIDUCIARY INCOME TAX
ADDRESS OF FIDUCIARY (NUMBER and STREET)
AMOUNT OF PAYMENT
CITY STATE ZIP CODE
DO NOT STAPLE OR TAPE CHECK TO YOUR FORM DO NOT CUT FORM DO NOT SEND PHOTOCOPIES OF FORMS
EXTENSION PAYMENT VOUCHER
Mail with check or money order payable to TREASURER STATE OF MAINE to:
Maine Revenue Services P O Box 9101 Augusta ME 04332 9101
NAME AND TITLE OF FIDUCIARY OR TRUSTEE FIDUCIARY SSN OR EIN (do not enter / or )
NAME OF ESTATE OR TRUST ESTATE/TRUST EIN
need to file 1041ME EXT or mail this completed form to make your extension payment
Pay electronically using Maine EZ Pay at www maine gov/revenue and eliminate the
Please
STATE OF MAINE
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