5754 Statement of Person(s) Receiving Gambling Winnings

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1040-V, PAGE 1 of 2
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
1
FLAT SIZE: 216mm (8 ⁄ 2 ") 3 279mm (11")
1
PERFORATE: 84.5mm (3 ⁄ 4 ") from bottom
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

2006

Action

Date

Signature

O.K. to print
Revised proofs
requested

Department of the Treasury
Internal Revenue Service

Form 1040-V

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What Is Form 1040-V and Do You Have To
Use It?

How To Send In Your 2006 Tax Return,
Payment, and Form 1040-V

It is a statement you send with your check or money
order for any balance due on the “Amount you owe”
line of your 2006 Form 1040. Using Form 1040-V
allows us to process your payment more accurately
and efficiently. We strongly encourage you to use Form
1040-V, but there is no penalty if you do not.

● Detach Form 1040-V along the dotted line.
● Do not staple or otherwise attach your payment or
Form 1040-V to your return or to each other. Instead,
just put them loose in the envelope.
● Mail your 2006 tax return, payment, and Form
1040-V in the envelope that came with your 2006 Form
1040 instruction booklet.

How To Fill In Form 1040-V

Line 1. Enter your social security number (SSN). If you
are filing a joint return, enter the SSN shown first on
your return.
Line 2. If you are filing a joint return, enter the SSN
shown second on your return.
Line 3. Enter the amount you are paying by check or
money order.
Line 4. Enter your name(s) and address exactly as
shown on your return. Please print clearly.

How To Prepare Your Payment
● Make your check or money order payable to the
“United States Treasury.” Do not send cash.
● Make sure your name and address appear on your
check or money order.
● Enter “2006 Form 1040,” your daytime phone
number, and your SSN on your check or money order.
If you are filing a joint return, enter the SSN shown first
on your return.
● To help process your payment, enter the amount on
the right side of your check like this: $ XXX.XX. Do not
use dashes or lines (for example, do not enter
xx
“$ XXX—” or “$ XXX 100 ”).

Note. If you do not have that envelope or you moved
or used a paid preparer, mail your return, payment, and
Form 1040-V to the Internal Revenue Service at the
address shown on the back that applies to you.
Paperwork Reduction Act Notice. We ask for the
information on Form 1040-V to help us carry out the
Internal Revenue laws of the United States. If you use
Form 1040-V, you must provide the requested
information. Your cooperation will help us ensure that
we are collecting the right amount of tax.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or
its instructions must be retained as long as their
contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by
Internal Revenue Code section 6103.
The average time and expenses required to
complete and file this form will vary depending on
individual circumstances. For the estimated averages,
see the instructions for your income tax return. If you
have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions
for your income tax return.

Cat. No. 20975C

Form

Form

Ä

Detach Here and Mail With Your Payment and Return

1040-V

Department of the Treasury
Internal Revenue Service (99)

Ä

OMB No. 1545-0074

Payment Voucher
©

2006

Do not staple or attach this voucher to your payment or return.

1 Your social security number (SSN)

2 If a joint return, SSN shown second 3 Amount you are
on your return
paying by check
or money order

4 Your first name and initial

1040-V

Dollars

Cents

Last name

If a joint return, spouse’s first name and initial

Last name

Home address (number and street)

Apt. no.

City, town or post office, state, and ZIP code

Cat. No. 20975C

(2006)