Arizona Form 204 - Application For Filing Extension - 2002

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Application for Filing Extension

ARIZONA FORM

2002

For Individual and Fiduciary Returns Only

204

USE BLACK OR BLUE INK ONLY.

For calendar year 2002 or ﬁ scal year beginning:

and ending:

Your ﬁ rst name and initial

Last name

Your Social Security Number

Spouse’s ﬁ rst name and initial

Last name

Spouse’s Social Security Number

Present home address - number and street, rural route, apt. no.

FOR DOR USE ONLY

City, town or post ofﬁ ce

State Zip Code + 4

Fill in ovals completely. Example:

Select only one:

Resident Personal Income Tax Forms:

= =

140

140A

140EZ

140PTC

140ET

Part-Year Personal Income Tax Form 140PY

Nonresident Personal Income Tax Form 140NR

Arizona Fiduciary Income Tax Form 141

= =

Select only one:

Automatic 4-month extension. Return due date August 15, 2003, or ﬁ scal year return due date ____/____/20____ for tax year ending ____/____/20____.

Additional 2-month extension. Return due date October 15, 2003, or ﬁ scal year return due date ____/____/20____ for tax year ending ____/____/20____.

An Arizona extension cannot be granted for more than six months beyond the original due date of the return.

Arizona will accept a valid federal extension for the period covered by the federal extension.

1 Tax liability for 2002. You may estimate this amount........................................................................................................................

2 Arizona income tax withheld during 2002.................................................................................................

3 Arizona estimated tax payments for 2002 ................................................................................................

4 Payments made with previous extension requests for your 2002 return..................................................

5 Credits you will claim on your 2002 return. See instructions on back. ....................................................

6 Add lines 2 through 5 ........................................................................................................................................................................

7 Balance of Tax: Subtract line 6 from line 1 .....................................................................................................................................

8 Enter the amount of payment enclosed. Make check payable to Arizona Department of Revenue; include SSN on payment. ......

You will be liable for the extension underpayment penalty if at least 90 percent of your tax liability disclosed by your return

has not been paid by the original due date of the return or if you do not attach a copy of the Arizona extension when you ﬁ le

your return. Interest accrues on any additional tax due from the original due date of the return until paid.

9 If you were previously granted an extension of time to ﬁ le for this tax year, check this box .......................................................

M M

D D

Y Y

Enter the date your extension was granted to:

State the reasons why an additional extension is needed:

Sign here only if you are requesting an additional two-month extension. You do not have to sign this form if you are requesting an automatic

four-month extension.

Under penalties of perjury, I declare that I have examined this form including accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any

knowledge.

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YOUR SIGNATURE