Application For Automatic Extension Of Time To File Grand Rapids Income Tax Return Form

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APPLICATION FOR AUTOMATIC EXTENSION OF TIME
TO FILE GRAND RAPIDS INCOME TAX RETURN
Prepare this form in duplicate. File the original with the Grand Rapids Income Tax Department on or before the
due date for filing a return. When the original is filed, it may be assumed that the extension is automatically
granted unless notified. Attach the duplicate to your Grand Rapids income tax return.
NAME
SOCIAL SECURITY OR
EMPLOYER I.D. NUMBER
NUMBER AND STREET
CHECK TYPE OF RETURN TO
BE FILED:
FORM GR-1040R
CITY, STATE & ZIP CODE
FORM GR-1040NR
FORM GR-1120
FORM GR-1065
REASON FOR EXTENSION REQUEST
The Uniform City Income Tax Ordinance limits the extension of time for filing annual returns to SIX
months from the original due date.
A _______ month extension of time until ____________________, _______, is hereby requested in which to
file the Grand Rapids Income Tax Return of the above for the taxable year beginning ____________________,
_______, and ending ____________________, _______.
TENTATIVE TAX
THE TAX TENTATIVELY DETERMINED TO BE DUE MUST BE PAID WITH THIS
EXTENSION.
1.
Tentative City of Grand Rapids Tax ......................................................... $ ___________
2.
Less:
a.
payments of Declaration of Estimated Income Tax ............................ $ ___________
b.
other credits .................................................................................... $ ___________
3.
BALANCE DUE .................................................................................. $ ___________
________________________________________
_________________
Signature of taxpayer, officer, or agent
Date
Rev. 12/99

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