Form Rd-112 - Wage Earner Application For Automatic Extension - Kansas, Missouri
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1WAGE EARNER
RD-112 (09/09)
CITY OF KANSAS CITY, MISSOURI
Phone (816) 513-1120
FINANCE DEPARTMENT
REVENUE DIVISION
414 EAST 12TH STREET
2ND FLOOR EAST
KANSAS CITY, MISSOURI 64106-2786
WAGE EARNER APPLICATION FOR AUTOMATIC EXTENSION
(A separate extension form must be filed for each account)
An extension is granted for a period of six (6) months. This is not an extension of time for
payment of taxes. This is a request for additional time to file your return. An automatic extension
of time to file will be granted upon the timely receipt of tax due (line 3C) and a completed
application for extension. If the extension of time is not granted, you will receive a denial notice.
Extension payment must be 90% of the tax due to avoid penalty and interest
Section A
Name
________________________________________________________________________________
Mailing
________________________________________________________________________________
Address
City/State :
_____________________________________________________
Zip: ____________________
Social Security Number: ______________________________________________________________________
Taxable Year:
From : ____/____/____
TO: ____/____/_____
Extension payment must be 90% of the tax due to avoid penalty and interest
Section B
1. Is the taxable period less than 12 months?
( ) NO
( ) YES
If YES , Please explain____________________________________________________
______________________________________________________________________
2. State in detail the reason why the extension is needed
_____________________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________________________________________________
3. Tax Information:
a. Estimated Taxable earnings (or net profits) $
___________________________
b. Tax due (1% of line 3a)
$
___________________________
c. Amount paid (should be the same as 3b) $
___________________________
(DO NOT SEND CASH)
Signature of Taxpayer
Print Name
Title
Date
Phone
Signature of Preparer
Print Name
Title
Date
Phone
FILE THIS FORM ON OR BEFORE DUE DATE OF RETURN (PLEASE SEE BACK)
Write your Social Security Number or FEIN on check and make payable to City Treasurer/Revenue.
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