Form 101 - Application For Extension Of Time To File A North Dakota Tax Return - 2010

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Form
North Dakota Offi ce Of State Tax Commissioner
Application for extension of time to fi le a
101
North Dakota tax return
(income and fi nancial institution tax returns only)
Did you apply for a federal extension?

If you applied for an extension to fi le your federal return, you do
not need to use this form—see the instructions for the procedures to follow to have the federal extension recognized.
Part 1
To be completed by Taxpayer
Complete lines 1 through 7 (see instructions to Part 1 on reverse side)
1. Name and address of taxpayer:
3. Taxpayer’s social security number (or FEIN):
Name (If a joint return, include both spouses’ names.)
______________________________________________________
_________________________________________________________
(If a joint return, include both spouses’ numbers.)
Address
_________________________________________________________
4. Tax year of taxpayer:
Address
_________________________________________________________
Calendar year ending December 31, 20 ____
City
State
Zip code
Fiscal year ending— _____________ ______ ______
_________________________________________________________
Month
Day
Year
Enter below the name and address of the person to whom the
5. An extension is requested to:
processed form should be sent if not to the taxpayer:
______________________________ _______________ _________________
______________________________________________________
Month
Day
Year
______________________________________________________
This is a request for an additional extension.
______________________________________________________
6. Reason for needing extension:
2. Type of tax return for which extension
____________________________________________________
is requested:
____________________________________________________
Form ND-1 or Form ND-EZ (individual)
Form 38 (estate or trust)
____________________________________________________
Form 58 (partnership)
7. Taxpayer signature:
Form 40 (C corporation)
______________________________________________
________________
Signature of taxpayer (or authorized representative)
Date
Form 60 (S corporation)
______________________________________________
________________
Form 35 (fi nancial institution)
Spouse’s signature, if joint return
Date
Other (identify) __________________________________
Prepayment of tax due
Do not send any payment with this form — see
in instructions.
Mail to: Offi ce of State Tax Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck ND 58505-0599
Part 2
To be completed only by the Offi ce of State Tax Commissioner
Reason for rejection:
Application was late—
The application must be postmarked
on or before the due date (or previously granted extended due
date) of the tax return.
No reason for extension provided—
An extension is
granted only for good cause. No reason for needing the exten-
sion was stated in the application.

Granted
_________________________
_______________
No good cause—
After reviewing the reason for needing an
Authorized initials
Date
extension, we do not fi nd good cause for an extension. (Note:
An inability to pay is not good cause for an extension.)
Multiple taxpayers or returns—
More than one taxpayer
or type of return was identifi ed on the application. A separate
application must be fi led for each taxpayer or type of return.
No signature—
The application must be signed by the tax-
payer. If married fi ling joint return, both spouses must sign.
Other ___________________________________

Rejected
_________________________
_______________
Authorized initials
Date
_________________________________________
_________________________________________
28215 (Revised 8/10)

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