Form It-9 - Application For Extension Of Time To File - 2013
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1
2Form
Indiana Department of Revenue
Due April 15, 2014
2013
Application for Extension of Time to File
IT-9
State Form 21006
(R12 / 9-13)
Your Social
Spouse’s Social
Security Number
Security Number
Your first name
Initial
Last name
If filing a joint return, spouse’s first name
Initial
Last name
Present address (number and street or rural route)
City
State
Zip/Postal code
• Complete Part 1 if you are making an extension payment.
• Complete Part 2 if you are not making an extension payment.
Part 1: Payment Information
Complete the worksheet on the back of this form to figure the amount to pay.
.00
1. State tax due from line J of worksheet ________________________________________State Tax
1
2. From line K of worksheet:
a. Enter your county code ____________________________________
.00
b. Enter county tax ______________________________________________ Your County Tax
2b
3. From line L of worksheet:
a. Enter spouse’s county code (if different from yours) ______________
.00
b. Enter spouse’s county tax __________________________________ Spouse’s County Tax
3b
.00
4. Add lines 1, 2b and 3b ____________________________________________ Extension Payment
4
• Please make your check or money order payable to: Indiana Department of Revenue.
See instructions for other payment options.
Part 2: Nonpayment Information
1. Place an “X” in the box if you are not intending to make a payment with this form __________________________ No Payment
Do not attach Form IT-9 to your tax return when filing.
Mail entire form with any payment due by April 15, 2014, to:
Indiana Department of Revenue
P.O. Box 6117
Indianapolis, IN 46206-6117
*01213111794*
01213111794
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