Municipal Income Tax Extension Request Form - The Tricota Member Cities

Municipal Income Tax Extension Request Form - The Tricota Member Cities - 2010

2010 - MUNICIPAL INCOME TAX EXTENSION REQUEST FORM - 2010

The TRICOTA Member Cities who will accept this extension form are: Alliance, Carrollton,

Columbiana, Geneva, Hubbard, Jefferson, Leetonia, Lisbon, Lordstown, Lowellville, Malvern,

McDonald, Middlefield, Orwell, Salem, Sebring, Struthers, Warren, and Windham. The Extension

Request Form must be received by April 15

the due date of the municipal income tax return.

Canfield, Newton Falls, & Niles will only accept a copy of the federal extension as a request

for an extension to file the municipal income tax return. This must be received by April 15

the due

date of the municipal income tax return.

For extension requirements for Campbell & East Palestine see

FOR MUNICIPALITY OF ____________________________ ACCOUNT NUMBER _________________

SSN __________________________________

EIN ____________________________________

NAME ________________________________________________________________________________

ADDRESS ____________________________________________________________________________

CITY __________________________________ STATE ________ ZIP CODE ____________________

I HEREBY REQUEST AN EXTENSION OF TIME FOR FILING THE MUNICIPAL INCOME

TAX RETURN FOR: ____ CALENDAR YEAR 2010 or ____ FISCAL YEAR ________

Please note: For taxable year 2010 the extended due date for filing the municipal income tax return is the

last day of the month following the month to which the due date of the federal income tax return has been

extended.

CHECK APPROPRIATE LINE AND COMPLETE IF NECESSARY:

_____ Individual 4 month extension to September 30, 2011

_____ Individual additional extension to November 30, 2011.

_____ Calendar year 3 month Partnership extension to August 31, 2011.

_____ Calendar year 6 month Corporate extension to October 31, 2011.

_____ Fiscal year 6 month Corporate extension to ___________________ _______, __________

I UNDERSTAND THIS IS NOT AN EXTENSION FOR PAYING THE TAX OWED.

________________________________________

Taxpayer Signature

Preparer Signature if other than Taxpayer

TRICOTA/EXT/10

Municipal Income Tax Extension Request Form - The Tricota Member Cities - 2010