Form Fr-127 - Extension Of Time To File Income Tax Or Fiduciary Return - 2003

2003

FR-127 Extension of Time to File

Income Tax or Fiduciary

*031270110000*

Gover nm ent of t he

Di st r i ct of Col um bi a

Return

I m por t ant :

Pr i nt i n CAPI TAL l et t er s usi ng bl ack i nk.

OFFI CI AL U SE ON LY

Leave l i nes bl ank t hat do not appl y .

Per sonal i nf or m at i on

Request i ng an ext ensi on f or :

I ndi vi dual I ncom e Tax Ret ur n ( D - 40, D- 40EZ)

Feder al Em pl oyer I D Num ber ( Fi duci ar y I ncom e Tax)

Fi l l i n one oval onl y .

Fi duci ar y I ncom e Tax Ret ur n ( D- 41)

I ndi vi dual s, ent er your f i r st nam e, m i ddl e i ni t i al , l ast nam e. Fi duci ar y , ent er nam e. ( Leave a space bet ween nam es and i ni t i al s. )

I ndi vi dual s, ent er your spouse’ s f i r st nam e, m i ddl e i ni t i al , l ast nam e. Fi duci ar y , ent er any second nam e i nf or m at i on. ( Leave a space bet ween nam es and i ni t i al s. )

Your soci al secur i t y num ber

Spouse’ s soci al secur i t y num ber

Your dayt i m e phone num ber

Hom e addr ess

Fi l l i n

i f t hi s i s your f i r st r et ur n or i f your addr ess changed f r om your l ast r et ur n.

Apar t m ent num ber

Ci t y

St at e

Zi p code

Round cent s t o t he near est dol l ar .

Ext ensi on unt i l Oct ober 15, 2004

I f t he am ount i s zer o, l eave t he l i ne bl ank.

$

. 00

1 Tot al est i m at ed i ncom e t ax l i abi l i t y f or 2003

1

$

. 00

2 DC i ncom e t ax w i t hhel d

2

$

. 00

3 2003 est i m at ed t ax paym ent s

3

$

. 00

4 Tot al paym ent s

4

Add Li nes 2 and 3.

$

. 00

5 Am ount due w i t h t hi s r equest .

5

I f Li ne 1 i s m or e t han Li ne 4, subt r act Li ne 4 f r om Li ne 1.

You m ust send paym ent i n f ul l w i t h t hi s f or m or your r equest w i l l be deni ed.

I f Li ne 4 i s m or e t han Li ne 1, l eave t hi s l i ne bl ank and send no paym ent .

At t ach check or m oney or der m ade payabl e t o DC Tr easur er . W r i t e your soci al secur i t y

num ber or FEI N and “ 2003 FR- 127” on your paym ent . You m ay not pay by cr edi t car d.

M ai l t hi s f or m , w i t h any paym ent due, by Apr i l 15, 2004.

Si gnat ur e

Your Si gnat ur e

Dat e

Spouse’ s si gnat ur e i f f i l i ng j oi nt l y or separ at el y on sam e r et ur n

Dat e

Send your si gned and com pl et ed or i gi nal f or m t o: Of f i ce of Tax and Revenue

941 N or t h Capi t ol St N E, 6t h f l oor

W ashi ngt on DC 20002- 4265

Keep a copy of t hi s f or m f or your r ecor ds.

2003 FR- 127 P1

Ext ensi on of Ti m e t o Fi l e I ncom e Tax or Fi duci ar y Ret ur n

Fi l e or der 6

Revi sed 10/ 03