Form Erf-Int - Extension Request Form

ADVERTISEMENT

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-INT)
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.
***TAXPAYER TO COMPLETE ALL INFORMATION WITHIN THE SHADED AREA***
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)
FOR TAX OFFICE USE ONLY
EXTENSION REQUEST GRANTED TO:
____________________________
EXTENSION REQUEST GRANTED BY:
____________________________
EXTENSION REQUEST DENIED:
REASON: ______________________________________________________________
TAX PREPARER’S INFORMATION
PREPARER’S NAME:
____________________________________________
PREPARER’S PHONE #:
____________________________________________
PREPARER’S FAX #:
____________________________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go