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2021 PA-40 ES INDIVIDUAL
(EX) 12-20
DECLARATION OF ESTIMATED PERSONAL INCOME TAX
DECLARATION OF ESTIMATED
PERSONAL INCOME TAX (PA-40 ES)
Use the 2021 Form PA-40 ES-I to make your quarterly
estimated payment of tax owed. Do not use this voucher for
any other purpose. Follow the instructions below.
SOCIAL SECURITY NUMBER (SSN)
● SSN - enter the primary taxpayer’s nine-digit SSN
without the hyphens.
● SSN - enter the spouse’s nine-digit SSN without the
hyphens.
DAYTIME TELEPHONE NUMBER
Enter the daytime telephone number of the taxpayer(s).
NAME OF TAXPAYER AND SPOUSE
● Print the last name, first name and middle initial of the
taxpayer and/or spouse.
DATE FILED
Enter the date you are making the payment in the following
format MMDDYYYY.
FISCAL FILERS ONLY
Don’t use these fields if you are a calendar year filer. If you
are a fiscal year filer you will need to enter the beginning
and ending of your fiscal year in the appropriate boxes in
the following format MMDDYYYY.
PAYMENT
Carefully enter the amount of the payment. Enter the
amount of the payment using dollars and cents without the
decimal place. Make the check or money order payable to
the PA DEPARTMENT OF REVENUE. Please write on the
check or money order:
● The last four digits of the primary taxpayer’s SSN;
● "2021 PA-40 ES"; and
● Quarter you are filing.
If the check or money order does not include the primary
taxpayer’s name, the department will also need the name
of the primary taxpayer as well as the information requested
above. In the event the check becomes separated from the
PA-40 ES-I, the department will need this information
to accurately apply the payment.
DECLARATION OF ESTIMATED TAX
Carefully enter the amount of the estimated tax expected to
be due for the entire year. Enter the amount using dollars
and cents without the decimal place.
MAILING ADDRESS
If filing a paper return, please remit payment with the return.
If filing electronically, please use the following address to
mail a payment to the department:
PA DEPARTMENT OF REVENUE
PO BOX 280403
HARRISBURG PA 17128-0403
ELECTRONIC SERVICES
Individuals can remit estimated, extension and tax due
payments through the department’s myPATH portal. Visit
mypath.pa.gov and select Estimated payment to pay via
electronic funds transfer. Additional services available
through myPATH include but are not limited to: filing a
PA-40, Personal Income Tax Return; checking the status of
a refund; updating an address; calculating penalty and
interest; and viewing notices issued by the department.
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Detach here
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DEPARTMENT USE ONLY
PRIMARY SSN
SPOUSE’S SSN
LAST NAME FIRST NAME MI
SPOUSE’S LAST NAME FIRST NAME MI
FIRST LINE OF ADDRESS
CITY STATE ZIP PHONE NUMBER
SECOND LINE OF ADDRESS
PAYMENT AMOUNT
2021 PA-40 ES DECLARATION OF ESTIMATED PERSONAL INCOME TAX
FISCAL FILERS ONLY - BEGINNING
DATE FILED
FISCAL FILERS ONLY - ENDING
Make check or money order
payable to the Pennsylvania
Department of Revenue
DECLARATION OF THE ESTIMATED TAX
PA-40 ES (I) (EX) 12-20 (FI)
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2102510050
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