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Form 7004 (Rev. 10-2000)

Page

● An attorney or certified public

Note: For all filers, the date that is

dotted line next to the entry space

entered on line 1a cannot be later

(e.g., for backup withholding, show

accountant qualified to practice

than 6 months from the original due

the amount on the dotted line next

before the IRS.

date of the retur n.

to line 5 and write “backup

withholding” next to it).

Paperwork Reduction Act

Line 1b—Short tax year. If the box

for change in accounting period is

For more information about

Notice

checked, the corporation must have

“write-in” payments and credits, see

We ask for the information on this

applied for approval to change its

the Instructions for Forms 1120 and

form to carry out the Internal

tax year unless certain conditions

1120-A, lines 32b through 32h, or

Revenue laws of the United States.

have been met.

the comparable instructions for

You are required to give us the

other applicable forms.

See Form 1128, Application To

information. We need it to ensure

Adopt, Change, or Retain a Tax Year,

Line 6—Balance due. This is the

that you are complying with these

and Pub. 538, Accounting Periods

amount of tax the corporation is

laws and to allow us to figure and

and Methods, for details.

required to deposit.

collect the right amount of tax.

Line 2—Affiliated group members.

Note: Except for certain foreign

You are not required to provide

Enter the name and address, EIN,

corporations descr ibed under

the information requested on a form

and tax period for each member of

Payment of Tax, make all deposits

that is subject to the Paperwork

the affiliated group. Generally, all

with Form 8109 or use EFTPS, if

Reduction Act unless the form

members of an affiliated group must

applicable. Do not include the

displays a valid OMB control

have the same tax period. However,

corporation’s payment with For m

number. Books or records relating to

if a group member is required to file

7004.

a form or its instructions must be

a separate return for a short period

If the corporation expects to have

retained as long as their contents

and an extension of time to file is

a net operating loss carryback, the

may become material in the

being requested, a separate Form

corporation may reduce the amount

administration of any Internal

7004 must be filed for that period.

to be deposited to the extent of the

Revenue law. Generally, tax returns

See Regulations section 1.1502-76

overpayment resulting from the

and return information are

for details.

carryback, providing all other prior

confidential, as required by section

Note: Failure to list members of the

year tax liabilities have been fully

6103.

affiliated group on line 2 may result

paid and Form 1138, Extension of

The time needed to complete and

in the group’s inability to elect to file

Time for Payment of Taxes by a

file this form will vary depending on

a consolidated return. See

Corporation Expecting a Net

individual circumstances. The

Regulations sections 301.9100-1

Operating Loss Carryback, is filed

estimated average time is:

through 301.9100-3.

with Form 7004.

Recordkeeping

5 hr., 44 min.

Line 3—Tentative tax. Enter the

Interest will be charged on any

Learning about the

tentative amount of total tax for the

part of the final tax due not shown

law or the form

1 hr., 22 min.

year, reduced by any nonrefundable

on line 6. The interest is figured from

Preparing the form

2 hr., 27 min.

credits against the tax. This amount

the original due date of the return to

Copying, assembling,

will usually be the tax shown on

the date of payment.

and sending the form

Form 1120, line 31, or the

For certain domestic and foreign

to the IRS

16 min.

comparable line of other returns.

corporations that use the automatic

If you have comments concerning

Line 4—Payments and refundable

extension of time to file under

the accuracy of these time

credits. Enter the payments and

Regulations section 1.6081-5,

estimates or suggestions for making

refundable credits described on lines

interest is figured from the 15th day

this form simpler, we would be

4a through 4f. On line 4b, include

of the 3rd month following the end

happy to hear from you. You can

special estimated tax payments for

of the tax year to the date of

write to the Tax Forms Committee,

certain life insurance companies and

payment.

Western Area Distribution Center,

beneficiaries of trusts. On line 4f,

Signature. The person authorized by

Rancho Cordova, CA 95743-0001.

include any credit for tax on

the corporation should sign Form

Do not send the tax form to this

ozone-depleting chemicals under

7004. This person may be:

address. Instead, see When and

section 4682(g)(2).

● An officer of the corporation;

Where To File on page 2.

Line 5—Total. Include any backup

● A duly authorized agent holding a

withholding in the total for line 5.

power of attorney;

Describe a “write-in” amount on the

● A person currently enrolled to

practice before the IRS; or

Form 7004 - Application For Automatic Extension Of Time To File Certain Business Income Tax, Information, And Other Returns - Instructions Page 2

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