This form contains 17 fields organized into 9 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Address
Address (see instructions) Text
Provide your mailing address exactly as instructed. Use the address where you wish to receive correspondence.
City, town, or post office Text
Enter the city, town, or post office corresponding to your mailing address.
State Text
Enter the two-letter abbreviation for your state. This field accepts a maximum of 2 characters.
Max length: 2 characters
ZIP code Text
Enter your ZIP code. If you have a ZIP+4 code, include the full 10-digit format as needed.
Max length: 10 characters
Identification
2 Your social security number Text
Enter your Social Security number in the proper format (for example, xxx-xx-xxxx). This field accepts up to 11 characters.
Max length: 11 characters
3 Spouse's social security number Text
Enter your spouse's Social Security number if applicable, formatted as xxx-xx-xxxx (up to 11 characters).
Max length: 11 characters
Other
Text
This field is unlabeled. Refer to the IRS instructions for guidance on what information should be entered here.
Payment
5 Total 2024 payments Number
Enter the total payments you have made for 2024 toward your tax liability. Use the amounts as directed in the form instructions.
7 Amount you're paying (see instructions) Number
Enter the amount you are paying as indicated in the instructions. This field is for recording your current tax payment.
Personal Information
1 Your name(s) (see instructions) Text
Enter your name(s) exactly as they appear on official documents. This is the primary identification field for the taxpayer.
Reference
See instructions Text
This field references additional instructions. Review the corresponding IRS guidance for more details on completing the form.
Special Conditions
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Select this box if you are a U.S. citizen or resident living outside the United States and Puerto Rico. Checking this indicates you are claiming the special filing condition available to taxpayers abroad, which may extend your filing deadline.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Select this box if you are filing as a nonresident alien. This option indicates that you meet the IRS criteria for nonresident filing and may be subject to different filing procedures.
Tax Liability
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Enter your estimated total tax liability for the tax year 2024. Provide the amount you expect to owe based on your income and deductions.
Voucher Info
topmostSubform[0].Page1[0].VoucherHeader[0].f1_1[0 Text
This field appears in the voucher header section. Enter the required voucher information as specified in the IRS instructions.
topmostSubform[0].Page1[0].VoucherHeader[0].f1_3[0 Text
This voucher header field accepts a short code (up to 2 characters). Enter the appropriate two-character code as directed.
Max length: 2 characters
topmostSubform[0].Page1[0].VoucherHeader[0].f1_2[0 Text
Another field from the voucher header. Provide the necessary voucher-related information per the IRS guidelines.