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CITY OF CINCINNATI
Then print the form and mail it to our office.
INCOME TAX BUREAU
805 CENTRAL AVENUE SUITE 600
CINCINNATI OH 45202-5756
EXTENSION REQUEST FORM
TAX YEAR
TAX YEAR END DATE
RETURN DUE DATE
EXTENSION REQUESTED
(Maximum 6 months)
The undersigned or duly authorized agent hereby requests an extension of time as indicated above within which to file the annual
Cincinnati Income Tax Return for the taxpayer account name and account number listed below. To the best of my knowledge and
belief, all other filing and payment requirements have been fulfilled. I understand an approved extension will be rescinded if the
taxpayer’s account is later found to be in arrears. The reason for this request is as follows:
An extension has been requested of the IRS for filing of the federal income tax return and the Cincinnati extension would not
be more than one month beyond the period requested for federal tax purposes.
Other (explain)
The taxpayer(s) has (have) complied with all filing and payment requirements of CMC Section 311
Signature/Date
IMPORTANT: To insure proper processing, type or print each taxpayer = s Cincinnati tax account number, name and SSN#/FID in the
format indicated below. Incomplete extension requests will not be processed or returned. Mailed requests are to be marked
“EXTENSION” in the lower left cover of the envelope. Allow six weeks for processing. When filing the return as extended, indicate
in the top margin of the return “EXTENSION GRANTED UNTIL (DATE)”.
CINCINNATI ACCOUNT #
TAXPAYER NAME
SSN/FID#
1)
2)
3)
4)
5)
6)
7)
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DISAPPROVED: REQUEST RECEIVED AFTER DUE DATE FOR FILING
SEE THE ENCLOSED REGULATION ON REQUIREMENTS FOR FILING EXTENSIONS
E-1 (01/97)