Form 355-7004 - Massachusetts Domestic Or Foreign Business/ Manufacturing Or Security Corporation Excise Return

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Form 355-7004

Application for Extension of Time to File

Rev. 9/95

Massachusetts Domestic or Foreign Business/

Massachusetts

Manufacturing or Security Corporation

Department of

Excise Return

Revenue

See the back for filing instructions and return address. Be sure to answer all questions.

For taxable year beginning

, ending

This application may be filed by general business/manufacturing corporations that are eligible to file Form 355A, 355B, 355C-A, 355C-B, 355S-A, 355S-B,

355SC or SBC. Corporations that file corporation excise returns other than those listed above, such as insurance companies, financial institutions, public

utilities, urban redevelopment companies, etc. must use Form 355-7004 Misc..

Part 1. Application for Extension

Name of corporation

Federal I.D. Number

Number and Street

City/town

State

Zip

Return to be filed:

Form 355A

Form 355B

Form 355S-A

Form 355S-B

Form 355C-A

Form 355C-B

Will a Massachusetts combined return be filed?

Form SBC (355)

Form 355SC

Yes

If “yes”, complete the other side.

Application is hereby made to the Commissioner of Revenue for the following

Check applicable box:

extension of time to file the return of the corporation named above.

A six-month automatic extension of time

Domestic Corporation (0167)

Foreign Corporation (0168)

B extension of time until________________________________________, 19 _________

All corporations filing other types of corporation excise returns must file Form 355-7004 Misc. when applying for extension of time.

Reason for extension (complete for either an automatic extension or an extension of more than six months):

DO NOT WRITE HERE

Part 2. Tentative Return

1 Estimated amount of tax for the taxable year (must be at least minimum tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________

2 Advance and/or estimated payments made (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________

3 Balance due with this application. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________

Payment in full of the amount shown in line 3 must be made with this application. If less than 50% of the total tax due for the taxable year is paid, the

extension is null and void, and penalties for a late return will be assessed from the original due date of the return.

Part 3. Sign Here

I declare under the penalties of perjury that I have been authorized by the above-named corporation to make this application and that to the best of my

knowledge and belief the statements made herein are true and correct.

Signature of Officer or Agent

Title

Date

‹

Individual or Firm Signature of Preparer

Address

Date

‹