2010 Individual Extension Request Form

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2010 INDIVIDUAL EXTENSION REQUEST FORM
Due on or before April 18, 2011
Purpose of Form: This form can be used to request an extension of time to file your 2010 City of Forest Park
Income Tax Return and make a Declaration of Estimated Tax due for 2011.
RESIDENT #1 NAME: _________________________________ SOCIAL SECURITY NUMBER:__________________________
RESIDENT #2 NAME: _________________________________ SOCIAL SECURITY NUMBER:__________________________
HOME ADDRESS: ___________________________________________________________________________________________
HOME PHONE NUMBER: _____________________________ BUSINESS PHONE NUMBER: ___________________________
ESTIMATE OF TAX DUE WITH 2010 EXTENSION REQUEST
1.
TOTAL ESTIMATED FOREST PARK 2010 INCOME……………………………………………………… $ _______________
2
MULTIPLY LINE 1 BY BLENDED TAX RATE OF 1.5% = TOTAL 2010 ESTIMATED TAX….………. $ ______________
3.
ESTIMATED TAX PAYMENTS AND CREDITS
A. FOREST PARK TAX WITHHELD BY EMPLOYER(S)…………………… $ ______________
B. ESTIMATED CREDIT FOR OTHER CITY TAX ……………….……..…... $ ______________
C. 2010 ESTIMATED TAX PAYMENTS …………………………………….. $ ______________
D. TAX OVERPAYMENT FROM PREVIOUS TAX YEAR …………………. $ ______________
E. TOTAL (ADD LINES A THROUGH D)………………………………………………………….…. $ _______________
4.
TOTAL ESTIMATED TAX DUE AND PAYABLE WITH THIS EXTENSION REQUEST
(SUBTRACT LINE 3E FROM LINE 2). IF LINE 3E IS GREATER THAN LINE 2, ENTER ZERO
ON LINE 6 AND SHOW AMOUNT ON LINE 4 AS AN OVERPAYMENT OF PRIOR YEAR TAX
ON THE 2010 TAX DECLARATION BELOW (LINE 10) ……………………………………………….…. $ _______________
PLEASE ATTACH A COPY OF THE FEDERAL EXTENSION OR STATE REASON FOR REQUEST:
DECLARATION OF ESTIMATED TAX FOR YEAR 2011
5.
TOTAL ESTIMATED 2011 INCOME ……………………………………………………………………..… $ _______________
6.
MULTIPLY LINE 5 BY TAX RATE OF 1.5% ………………………………………………………………. $ _______________
7.
ESTIMATED PAYMENTS AND CREDITS:
A. FOREST PARK TAX WITHHELD BY EMPLOYER(S)…………………… $ ______________
B. ESTIMATED CREDIT FOR OTHER CITY TAX …. …………….………... $ ______________
C. TOTAL 2011 ESTIMATED CREDITS ………………………..…………………….……………… $ _______________
8.
TOTAL ESTIMATED TAX DUE AND PAYABLE TO FOREST PARK DURING 2011
(SUBTRACT LINE 7C FROM LINE 6) …………………..………………………………………… $ _______________
9.
AMOUNT TO BE PAID WITH THIS DECLARATION (1/4 OF LINE 8 DUE BY 4/15/2011)………..…… $ _______________
10. TAX DUE OR OVERPAYMENT FROM 2010 (ENTER AMOUNT FROM LINE 4 ABOVE)…………….. $ _______________
11. AMOUNT DUE FOR 2011 (SUBTRACT LINE 10 FROM LINE 9) …………..……………………………. $ _______________
12. TOTAL AMOUNT DUE (ADD LINES 4 AND 11) MUST BE ENCLOSED ………..…...………………. $ _______________
___________________________________________
_____________
_______________________________
Signature of Person Preparing Extension
Date
Phone Number

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