Application For Extension Of Time To File An Income Tax Return Form - 2004

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2004
CITY NAME
2004
APPLICATION FOR EXTENSION OF TIME
TO FILE AN INCOME TAX RETURN
Prepare this form in duplicate. File the original with the City’s Income Tax Department on or before the
due date for filing a return. Attach the duplicate to your city income tax return.
Name
Social Security Number
Address (Street number and name)
Mark type of return to be filed
Form CF-1040N
City, State & Zip Code
Form CF-1040R
Reason for extension request
The City Income Tax Ordinance limits the extension of time for filing annual returns to SIX months
from the original due date.
A _______ month extension of time is hereby requested in which to file the income tax return of the
above named taxpayer. The extended due date of the return is the last day of _______________, 2005
TENTATIVE TAX RETURN
THE TENTATIVE TAX BALANCE DUE MUST BE PAID WITH THIS EXTENSION.
1.
Tentative Tax (Estimate total tax liability)............................................ $ ___________
2.
Less:
a.
Estimated income tax payments..................................................... $ ___________
b.
Other credits .................................................................................. $ ___________
3.
BALANCE DUE (Line 1 less lines 2a and 2b) .................................. $ ___________
(Include payment of this amount with extension)
The extension is automatically granted upon payment of the tentative tax balance due.
Failure to pay the tentative tax balance due invalidates the extension request.
An extension filed without a payment will not be accepted.
________________________________________
_________________
Signature of taxpayer, officer or agent
Date
_____________________________________________________________________________________
MAIL TO: (Print address for the named city.)
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