*1234200*
A State of Maine extension request form is not necessary To make a payment of tax due
Address Federal ID Number
Augusta ME 04332 9101
Caution: At least 90% of your Maine franchise tax liability must be paid by the original
City State Zip Code (with extension)
complete and submit this voucher by the original date of your return
Date Return is Due
due date of your return in order to avoid a penalty for failure to pay tax on time
EXTENSION PAYMENT VOUCHER
EXTENSION PAYMENT VOUCHER INSTRUCTIONS
Financial Institution Name Amount of Payment
FOR MAINE FRANCHISE TAX
For tax period: 2014
FORM 1120B EXT/ME
Maine Revenue Services
MM DD YYYY MM DD YYYY
P O Box 9101
PLEASE DO NOT STAPLE OR TAPE CHECK TO YOUR FORM INCLUDE THE ORIGINAL FULL SHEET OF THIS FORM WITH YOUR PAYMENT
Rev 06/14
Send your voucher with payment for any estimated tax due to:
