Request Form For Automatic Extension Of Time To File Income Tax Return - City Of Mt.healthy

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CITY OF MT. HEALTHY
REQUEST FOR AUTOMATIC EXTENSION OF TIME TO FILE INCOME TAX RETURN
Name: __________________________
Signature:
_________________________
Address:
____________________
Title:
_________________________
________________________________
Date:
_________________________
________________________________
Federal ID #: _________________________
Or
SS #:
_________________________
I request an automatic 6-month extension of time until ___________________________________
To file the income tax return for:
____ calendar year _______ or tax year beginning ____________________ and ending
________________________.
To receive an acknowledgement of the filing of your extension request, enclose a stamped, self-addressed
envelope and a duplicate copy of this extension request.

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