Application For Extension Of Time To File Income Tax Return Form - City Of Highland Park
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2City of Highland Park
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20
APPLICATION FOR EXTENSION OF TIME
TO FILE 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
ling a return. Attach the duplicate to your city income tax return.
NAME
TAXABLE PERIOD
Calendar Year ______________________________________________
Fiscal Year Ending __________________________________________
TYPE OF RETURN
ADDRESS (STREET NUMBER AND NAME)
Corporation
Individual
Partnership
Resident
Estate or Trust
Non-Resident
CITY, STATE & ZIP CODE
Employer Identi cation Number or
Social Security Number
_________________________
Reason for extension request:
The City Income Tax Ordinance limits the extension of time for ling annual returns to SIX months from the original due date.
A __________ month extension of time is hereby requested in which to le the income tax return of the above named Taxpayer. The
extended due date of this return is the last day of ____________________, 20
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 payment . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
b.
Other credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
3.
BALANCE DUE (Line 1 less lines 2a 2b) . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
(Include payment of this amount with extension)
The extension is automatically granted upon payment of the tentative tax balance due. Failure to pay tentative
tax if due) could result in penalty for failure to pay.
____________________________________________________
__________________________
Signature of taxpayer, of cer or agent
Date
MAIL TO: City of Highland Park
Income Tax Department
P.O. Box 239
Eaton Rapids, Mi 48827
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