Tax Payments

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Your Name Taxpayer Social Security No

Estimated Tax Payments
		FEDERAL		STATE		Local
Due Date		Actual Payment Date	Amount	Actual Payment Date	Amount	Actual Payment Date	Amount
1.	April 15, 2005
2.	June 15, 2005
3.	September 15, 2005
4.	January 16, 2006
	Carryover from 2004 year
	2004 overpayment applied to 2005
	Amount from K-1 Estates & Trusts
	Withholding on Forms W-2G
	Withholding on Forms 1099-R
	Withholding on Forms 1099-MISC
	Withholding from interest income
	Withholding from dividend income
	Withholding from SSA, RRB, 1099G
	Nontaxable combat pay election
	Other withholding
	Tax paid with 2004 extension
	2004 estimated tax paid in 2005
	Other (Tax paid with 2004 return, or or for previous years)