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Form 4868 (2016)

Page

And you’re making a payment, send

And you’re not making a

Where To File a Paper Form 4868

Form 4868 with your payment to

payment, send Form 4868 to

Internal Revenue Service:

Department of the Treasury,

If you live in:

Internal Revenue Service Center:

Alabama, Georgia, Kentucky, New Jersey, North Carolina, South Carolina,

P.O. Box 931300 Louisville, KY 40293-1300

Kansas City, MO 64999-0045

Tennessee, Virginia

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts,

Missouri, New Hampshire, New York, Pennsylvania, Rhode Island, Vermont,

P.O. Box 37009 Hartford, CT 06176-7009

Kansas City, MO 64999-0045

West Virginia

Florida, Louisiana, Mississippi, Texas

P.O. Box 1302 Charlotte, NC 28201-1302

Austin, TX 73301-0045

Alaska, Arizona, California, Colorado, Hawaii, Idaho, Nevada, New Mexico,

P.O. Box 7122 San Francisco, CA 94120-7122

Fresno, CA 93888-0045

Oregon, Utah, Washington, Wyoming

Arkansas, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Montana,

P.O. Box 802503 Cincinnati, OH 45280-2503

Fresno, CA 93888-0045

Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, Wisconsin

A foreign country, American Samoa, or Puerto Rico, or are excluding income

under Internal Revenue Code section 933, or use an APO or FPO address, or file

P.O. Box 1302 Charlotte, NC 28201-1302 USA

Austin, TX 73301-0215 USA

Form 2555, 2555-EZ, or 4563, or are a dual-status alien, or are a nonpermanent

resident of Guam or the U.S. Virgin Islands

All foreign estate and trust Form 1040NR filers

P.O. Box 1303 Charlotte, NC 28201-1303 USA

Cincinnati, OH 45999-0048 USA

All other Form 1040NR, 1040NR-EZ, 1040-PR, and 1040-SS filers

P.O. Box 1302 Charlotte, NC 28201-1302 USA

Austin, TX 73301-0045 USA

Private Delivery Services

on this form. Under section 6109, you must disclose your social

security number or individual taxpayer identification number.

You can use certain private delivery services designated by the IRS

Routine uses of this information include giving it to the Department

to meet the “timely mailing as timely filing/paying” rule for tax

of Justice for civil and criminal litigation, and to cities, states, the

returns and payments. These private delivery services include only

District of Columbia, and U.S. commonwealths and possessions for

the following.

use in administering their tax laws. We may also disclose this

• DHL Express: DHL Express 9:00, DHL Express 10:30, DHL

information to other countries under a tax treaty, to federal and

Express 12:00, DHL Express Worldwide, DHL Express Envelope,

state agencies to enforce federal nontax criminal laws, or to federal

DHL Import Express 10:30, DHL Import Express 12:00, and DHL

law enforcement and intelligence agencies to combat terrorism. If

Import Express Worldwide.

you fail to provide this information in a timely manner or provide

incomplete or false information, you may be liable for penalties.

• United Parcel Service (UPS): UPS Next Day Air Early AM, UPS

Next Day Air, UPS Next Day Air Saver, UPS 2nd Day Air, UPS 2nd

You aren’t required to provide the information requested on a

Day Air A.M., UPS Worldwide Express Plus, and UPS Worldwide

form that is subject to the Paperwork Reduction Act unless the form

Express.

displays a valid OMB control number. Books or records relating to a

form or its instructions must be retained as long as their contents

• Federal Express (FedEx): FedEx First Overnight, FedEx Priority

may become material in the administration of any Internal Revenue

Overnight, FedEx Standard Overnight, FedEx 2 Day, FedEx

law. Generally, tax returns and return information are confidential,

International Next Flight Out, FedEx International Priority, FedEx

as required by Internal Revenue Code section 6103.

International First, and FedEx International Economy.

The average time and expenses required to complete and file this

The private delivery service can tell you how to get written proof

form will vary depending on individual circumstances. For the

of the mailing date.

estimated averages, see the instructions for your income tax return.

Private delivery services can’t deliver items to P.O. boxes.

If you have suggestions for making this form simpler, we would

You must use the U.S. Postal Service to mail any item to an

CAUTION

be happy to hear from you. See the instructions for your income tax

IRS P.O. box address.

return.

Privacy Act and Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue laws of

the United States. We need this information so that our records will

reflect your intention to file your individual income tax return within 6

months after the regular due date. If you choose to apply for an

automatic extension of time to file, you’re required by Internal

Revenue Code section 6081 to provide the information requested

Form 4868 - Application For Automatic Extension Of Time To File U.s. Individual Income Tax Return - 2016 Page 4

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