Mail
a
ment and voucher to: Office of State Tax Commissioner
PO Box 5621
Bismarck, ND 58506-5621
ND-1PRV
City, State, ZIP Code
Mailing Address
Name
Social Securit
Number . . . . . . . . . . . . .►
Spouse's Name
Do not use this voucher if
a
in
electronicall
2021
S
ouse's Social
Security Number . . . . .
►
FORM ND-1PRV INDIVIDUAL PAPER RETURN PAYMENT VOUCHER
North Dakota Office of State Tax Commissioner
SFN 28756
12-2021
Payment Amount ►
$
Write last four di
its of
social securit
number and
"2021 ND-1PRV" on check
•
Make
a
able to:
ND State Tax Commissioner
•
What is Form ND-1PRV?
The 2021 Form ND-1PRV is a payment voucher that you
complete and send in with your return if you:
●
arelingyour2021FormND-EZorFormND-1on
paper,
●
have a balance due on your return, and
● arepayingthebalanceduewithapapercheckormoney
order.
Do not use Form ND-1PRV if you led or are going
to le your return electronically, or are paying
a balance due electronically - see “Electronic
payment option.”
Also do not use this form to make an extension
payment; instead, if you have an extension of time
to le your Form ND-1 and you want to make an
advance payment of an expected balance due on it,
use Form ND-1EXT.
When is the payment due?
Abalancedueona2021FormND-EZor2021
Form ND-1 must be paid on or before April 15, 2022, to
avoidanylatepaymentpenaltyandinterestcharges.
How to make payment
Makeyourcheckormoneyorderpayableto“NDState
TaxCommissioner.”Writethelastfourdigitsofyour
socialsecuritynumberand“2021ND-1PRV”onyour
checkormoneyorder.Completethepaymentvoucher,
detachitfromthispage,andmailitwithyourpayment
and return to:
OceofStateTaxCommissioner
PO Box 5621
Bismarck,ND58506-5621
OnlyacheckdrawnonaU.S.orCanadianbankinU.S.
dollarsandusingastandard9-digitroutingnumberis
accepted.
Electronic payment option. Insteadofpayingbycheck
or money order with this payment voucher, the payment
maybemadeonlinewithanelectroniccheckoradebit
orcreditcard.Theelectroniccheckoptionisfree.North
Dakotacontractswithanationalpaymentserviceto
provide the debit or credit card option, for which there is
afee,noneofwhichgoestotheStateofNorthDakota.If
paying electronically, do not use this voucher. Tomakean
electronicpayment,gotowww.nd.gov/tax/payment.
Need help?
Phone: 701-328-1242
Speechorhearingimpaired-800-366-6888
Email: individualtax@nd.gov
Privacy Act Notication. In compliance with the Privacy Act of 1974,
disclosure of a social security number or Federal Employer Identication
Number (FEIN) on this form is required under N.D.C.C. §§ 57-01-15
and 57-38-31, and will be used for tax reporting, identication, and
administration of North Dakota tax laws. Disclosure is mandatory. Failure
to provide the social security number or FEIN may delay or prevent the
processing of this form.
▼ Detach here and mail with payment ▼
INDIVIDUAL PAPER RETURN PAYMENT VOUCHER
OFFICE OF STATE TAX COMMISSIONER
SFN 28756 (12-2021)
Form ND-1PRV
2021