Form Erf - Extension Request Form

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FOR TAX OFFICE USE
FOR TAX OFFICE USE
ONLY:
ONLY:
DATE: ______________________
YEAR: _________________
CITY OF GREENVILLE
BATCH: ____________________
ACCT: _________________
Department of Taxation
100 Public Square
Greenville, Ohio 45331-1499
Telephone Number (937) 548-5747
Fax Number (937) 548-3035
EXTENSION REQUEST FORM
(FORM ERF)
NOTE: COMPLETED EXTENSION REQUEST FORMS MUST BE RECEIVED BY THE TAX DEPARTMENT
ON OR BEFORE THE ORIGINAL DUE DATE OF THE RETURN. LATE REQUESTS WILL BE ACCEPTED,
BUT WILL BE SUBJECT TO ALL APPLICABLE LATE FILING PENALTIES.
th
Estimated tax should be paid by April 15
.
This extension does not waive penalty & interest of the tax liability.
SECTION A – TAXPAYER INFORMATION
DATE OF REQUEST: ___________________________
FOR TAX YEAR: _____________
ORIGINAL DUE DATE OF RETURN: ___________________________
EXTENSION REQUESTED TO (DATE): ___________________________ (NOT TO EXCEED SIX (6) MONTHS)
TAXPAYER’S NAME:
__________________________________________________________________________
(IF FILING A JOINT RETURN, LIST BOTH NAMES)
STREET ADDRESS:
__________________________________________________________________________
CITY, STATE & ZIP:
__________________________________________________________________________
SSN OR FIN:
__________________________________________________________________________
(IF FILING A JOINT RETURN, LIST BOTH SSN’S)
SECTION B – PREPARER INFORMATION
PREPARER’S NAME:
____________________________________________
PREPARER’S PHONE #:
____________________________________________
PREPARER’S FAX #:
____________________________________________
SECTION C – TAX OFFICE USE ONLY
REQUEST GRANTED TO: ____________________________
EXTENSION REQUEST GRANTED BY:
____________________________

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