Attention:
This form is provided for informational purposes and should
not be reproduced on personal computer printers by individual
taxpayers for filing. The printed version of this form is
designed as a "machine readable" form. As such, it must be
printed using special paper, special inks, and within precise
specifications.
Additional information about the printing of these specialized
tax forms can be found in IRS Publications 1141, 1167, 1179,
and other IRS resources.
The printed version of the form may be obtained by calling
1-800-829-4933. Be sure to order using the IRS form or
publication number.
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For Information OnlyDo Not File3
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SEPARATE ALONG THIS LINE AND SUBMIT TO DEPOSITARY WITH PAYMENT
OMB NO. 1545-0257
Note. Except for the name, address, and telephone number, entries must
be made in pencil. Use soft lead (for example, a #2 pencil) so that the
entries can be read more accurately by optical scanning equipment. The
name, address, and telephone number may be completed other than by
hand. You cannot use photocopies of the coupons to make your
deposits. Do not staple, tape, or fold