Form Cd-419 - Application For Extension Of Time To File The Corporate Franchise And Income Tax Return - North Carolina Department Of Revenue

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Form CD--419
NORTH CAROLINA
(Rev. 9--98)
Application for Extension of Time
to File the Corporate Franchise and Income Tax Return
Federal Employer I.D. Number
Name
"
Sec. of State ID Number
Street Address
"
State of Incorporation
City, State and Zip Code
Type of Business
Is this the first time you have filed a North Carolina tax return?
Yes
No
Yes
No
Is the name and/or address on this return different from last year’ s return?
Nonprofit
Cooperative or Mutual Association
Indicate If:
Effective January 1, 1998, and applying to tax years ending on or after December 31, 1997, all corporations authorized
to transact business in North Carolina except for insurance companies, limited liability companies, nonprofit corporations,
and professional associations must file a corporate annual report with the Department of Revenue and remit a twenty dollar
($20.00) fee by the due date of the corporation’ s income and franchise tax return. This twenty dollar ($20.00) fee should
be included in the estimation of the corporation’ s income tax liability (line 3). Do not attach the Annual Report, CD--479,
to this application for extension. The Annual Report must be attached to the front page of the North Carolina Corporate
Franchise and Income Tax Return.
,
An automatic 7 month extension is requested to
, 19
.
"
for the period/year beginning
, 19
and ending
, 19
TOTAL TAX PAYMENT
Franchise
1.
Total Franchise Tax Liability Expected -- (Min. Tax $35.00) . . . . .
1
$
2.
Amount of Franchise Tax Remitted . . . . . . . . . . . . . . . . . . . . . . . . .
2
$
"
Income
3.
Total Income Tax Liability Expected . . . . . . . . . . . . . . . . . . . . . . . . .
3
$
4.
Less: Amount Previously Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
$
$
5.
Amount of Income Tax Remitted . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
"
6.
Total Franchise & Income Tax Paid with this Application
$
6
00
(Add lines 2 and 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
D ATTACH REMITTANCE FOR THE TOTAL AMOUNT OF LINE 6 AND MAKE CHECK PAYABLE TO:
NORTH CAROLINA DEPARTMENT OF REVENUE
P. O. BOX 25000
RALEIGH, N. C. 27640--0001
I certify that, to the best of my knowledge, this return is accurate and complete.
Date
Signature and title of officer
Date
Signature of preparer other than taxpayer
Preparer’ s Name and Address
Preparer’ s EIN or SSN

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