Form 204 - Application For Filing Extension (Individual And Fiduciary Returns Only) (1998)

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1998

Application For Filing Extension

ARIZONA FORM

(Individual and Fiduciary Returns Only)

204

Mail to: Arizona Department of Revenue, PO Box 29002, Phoenix AZ 85038-9002

For calendar year 1998 or fiscal year beginning ____________, 19_____ and ending ____________, 19_____.

First name and initial - If joint return also give spouse's name & initial

Last name

Your social security number

Apt. No.

Present home address - number and street, including apartment number or rural route

Spouse's social security number

City, town or post office

State

ZIP code

For DOR use only

Check only one:

Type of

Resident Personal Income Tax Forms: 140

140A

140EZ

140PTC

Return

Part-Year Personal Income Tax Form 140PY

Nonresident Personal Income Tax Form 140NR

Arizona Fiduciary Income Tax Form 141

Type of

Check only one:

Extension

Automatic 4-month extension. Return due date August 16, 1999

(Or if a fiscal year, to ______________, 19______ for the tax year ending _____________, 19______)

Additional 2-month extension. Return due date October 15, 1999

(Or if a fiscal year, to ______________, 19______ for the tax year ending _____________, 19______)

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.

Taxes

Owed

1 Tax liability for 1998. You may estimate this amount ...........................................................................................................

2 Arizona income tax withheld during 1998 ..............................................................................

See

3 Arizona estimated tax payments for 1998 .............................................................................

instructions

4 Payments made with previous extension requests for your 1998 return ...............................

on back

5 Credits you will claim on your 1998 return. See instructions on back ...................................

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

7 Balance of tax (line 1 less line 6) .......................................................................................................................................

Attach

8 Payment Enclosed. Enter the amount of payment enclosed ..............................................................................................

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

EXTENSION WHEN YOU FILE 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 file for this tax year, check this box ................................................

YES

Questions

Month

Day

Year

If yes, enter date your extension was granted to:

If yes, state reasons below why additional extension is needed:

Make Checks Payable To: Arizona Department of Revenue

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.

Your signature

Date

Occupation

Please

Sign

Spouse's occupation

Spouse's signature

Date

Here

Firm's name (preparer's if self-employed)

Preparer's signature