Form Ft-Es, State Form 49410, Form Ft-Ext, State Form 49171 - Indiana Financial Institution Tax Return Department Of Revenue - 2004

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Indiana Department of Revenue
Form FT-ES
State Form 49410
Indiana Financial Institution Tax Return - Estimated Quarterly Payment
(8-04)
Due the 20th day of the 4th, 6th, 9th and 12th month of the tax year.
(Do Not Write Above)
Name
________________________________________________________
Address ________________________________________________________
________________________________________________________
Federal Identification Number
Signature of Officer
Title
Voucher Number
Calendar or Fiscal Year Ending
Due Date
(Enter MM-YYYY)
(Enter MM-DD-YYYY)
(Enter 1,2,3, or 4)
Date
Daytime Phone #
Financial Institution Tax Due for the Quarter
No.
Enter Total Tax Below:
Indiana Taxpayer Identification Number ________________________________
INDIANA DEPARTMENT OF REVENUE
Pay this amount, with U. S. funds.
Do not send cash.
100 NORTH SENATE AVENUE
Please make check payable to the Indiana Department of Revenue.
INDIANAPOLIS IN 46204-2253
Instructions for Form FT-EXT
The extension return, Form FT-EXT, is to be used when a payment is due and additional time is necessary for filing the
annual Indiana Financial Institution Tax Return (FIT-20). A penalty for late payment will not be imposed if at least ninety (90)
percent of the tax is paid by the original due date and the remaining balance, plus interest, is paid in full by the extended due
date.
Form FT-EXT
Indiana Department of Revenue
State Form 49171
Indiana Financial Institution Tax Return - Extension Payment
(8-04)
Due 15th day of the 4th month following close of your tax year.
(Do Not Write Above)
Name
________________________________________________________
Address ________________________________________________________
________________________________________________________
Signature of Officer
Title
Federal Identification Number
Date
Daytime Phone #
Calendar or Fiscal Year Ending
Due Date
Enter Financial Institution Tax Return Extension
Extension
(Enter MM-YYYY)
(Enter MM-DD-YYYY)
Payment Below:
Payment
Pay this amount, with U. S. funds.
Do not send cash.
Indiana Taxpayer Identification Number ______________________________
INDIANA DEPARTMENT OF REVENUE
Please make check payable to the Indiana Department of Revenue.
100 NORTH SENATE AVENUE
INDIANAPOLIS IN 46204-2253
19

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