Form 228ext - Extension Request - Lexington-Fayette Urban County Government printable pdf download

Lexington-Fayette Urban County Government

EXTENSION REQUEST

CHECK IF CHANGE IN ADDRESS IS BELOW

Name

____________________________________

ACCOUNT NO

Address

____________________________________

TAX YEAR ENDING

City

_________________________________ State _________ Zip _____________

Phone

__________________________ Ext _________

Each individual taxpayer or business entity registered with this agency for the purpose of reporting local

occupational taxes must apply separately to this agency for an extension of time within which to file their local tax

return. This application must be submitted by the 15th day of the fourth month following the close of the tax year

and allows a six (6) month extension of time in which to file the return.

Office Use Only

Individual Social Security Number ______________________________

Federal ID Number, if applicable _______________________________

An estimated payment of $____________________ is enclosed.

Pursuant to KRS 67.790, there is a minimum $25.00 penalty for failure to file and/or pay any return or

report by the due date.

INTEREST - Full payment of tax due must be paid by the original due date of the return to avoid interest charges

of 1% per month. Interest is assessed from the regular due date of the return until the tax due is fully paid.

NOTICE - CORPORATIONS AND PARTNERSHIPS: If this extension request is for a tax period of less than

twelve (12) months, please indicate the reason below.

[

] Tax year end changed to: ______/______/______.

[

] Final return -- Business ceased ______/______/______.

[

] Corporate Merger -- Short year return due to merger on ______/______/______ with:

Name and address:__________________________________________________________________

Federal ID:________________________________

After this short year return, our tax year will end on ______/______/______.

[

] Corporate Acquisition -- Short year return due to the acquisition on ______/______/______ by:

Name and address:__________________________________________________________________

Federal ID:________________________________

After this short year return, our tax year will end on ______/______/______.

[

] Other: (Please explain.) ________________________________________________________________

_________________________________________________________________

_________________________________________________

Signature of Preparer

________________________________________________

______________________

Print Name

Date

MAIL TO: DIVISION OF REVENUE, PO BOX 14058, LEXINGTON, KY 40512

Form 228EXT Revised 2/10

Form 228ext - Extension Request - Lexington-Fayette Urban County Government

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