Income Tax Return Form - Extension Request - City Of Springsboro

Income Tax Return Form - Extension Request - City Of Springsboro - 2011

2011 EXTENSION REQUEST

CITY OF SPRINGBORO

INCOME TAX RETURN

• Submit copy of Federal Extension with this form.

• Payment of tax due for 2011 (if applicable):

$_________________________________________

• Payment for the first quarter estimate of 2012 (if applicable):

$_________________________________________

• An extension of time to file extends the due date for filing the return only. Payment in full must be

made or extension may be disallowed.

• Please Complete:

Taxpayer Name:_______________________________________________________________

Account Number:______________________________________________________________

Address:_____________________________________________________________________

Social Security Number:________________________________________________________

Signature of Taxpayer:__________________________________________________________

Date:________________________________________________________________________

EXTENSION FORM MUST BE COMPLETED AND RETURNED BY

APRIL 17, 2012, FOR AN EXTENSION TO BE GRANTED. BE SURE TO

INCLUDE FULL PAYMENT OF TENTATIVE TAX DUE, COPY OF FEDERAL

EXTENSION REQUEST AND/OR THIS FORM. A PENALTY AND

INTEREST CHARGE WILL BE ASSESSED FOR ALL PAYMENTS

RECEIVED AFTER APRIL 17

Income Tax Return Form - Extension Request - City Of Springsboro - 2011