Form As - Request For Extension Of Time To File The Estimated Tax Declaration

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Número de Serie
Modelo SC 2650
ESTADO LIBRE ASOCIADO DE PUERTO RICO
Form AS
COMMONWEALTH OF PUERTO RICO
Rev. 08 .97
DEPARTAMENTO DE HACIENDA
DEPARTMENT OF THE TREASURY
SOLICITUD DE PRORROGA PARA RENDIR LA DECLARACION DE CONTRIBUCION ESTIMADA
REQUEST FOR EXTENSION OF TIME TO FILE THE ESTIMATED TAX DECLARATION
Año comienza el __ de ________ de 19 __ y termina el__ de ________ de 19 __
Year beginning on __________ of 19 __ and ending on __________ of 19 __
Clase de Contribuyente
Individuos
Corporaciones /Sociedades
USO OFICIAL
Type of Taxpayer
Individuals
Corporations/Partnerships
OFFICIAL USE
Sello de Recibo
Número de Seguro Social o Identificación Patronal:
Social Security or Employer Identification Number:
Nombre
Inicial
Apellido Paterno
Apellido Materno
First Name
Initial
Last Name
Second Last Name
Nombre de la Corporación o Sociedad -
Name of the Corporation or Partnership
Dirección Postal -
Postal Address
Fecha de Vencimiento para Rendir Declaración
Teléfono de la oficina
Teléfono residencial
Date Declaration is Due
Acción:
Denegado
Office telephone
Home telephone
Aprobado
Día-
______ Mes-
______Año-
______
Day
Month
Year
De acuerdo con las disposiciones del Código de Rentas Internas de Puerto Rico de 1994, según enmendado, someto esta
solicitud de prórroga para rendir la Declaración de Contribución Estimada por las siguientes razones:
According to the Puerto Rico Internal Revenue Code of 1994, as amended, I submit this application for extension to file the Estimated Tax Declaration
for the following reasons:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Número de días solicitados:
Menos de 90 días, indique cantidad de días ______
90 días
Number of days requested:
Less of 90 days, indicate number of days ______
90 days
JURAMENTO - OATH
Declaro bajo penalidad de perjurio, que la información aquí suministrada ha sido examinada por mí y que según mi mejor
información y creencia es cierta, correcta y completa.
I hereby declare under penalty of perjury, that this information has been examined by me and to the best of my knowledge and belief is true, correct and
complete.
Fecha -
Firma del Contribuyente o su Representante Autorizado
Tltulo-
Date
Title
Signature of the Taxpayer or Duly Authorized Agent
(VEA INSTRUCCIONES AL DORSO -
)
SEE INSTRUCTIONS ON BACK

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