Form Fr-128 - Extension Of Time To File D.c. Franchise Or Partnership Return - 2002 Page 2
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2FR-128 PAGE 2
*021280120000*
TAXPAYER NAME :
FEDERAL EMPLOYER I.D. NUMBER/SSN :
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct. Declaration of paid
preparer is based on all information available to the preparer.
PLEASE
SIGN
HERE
Telephone Number of Person to Contact
-
-
CORPORATE
TAXPAYER(S) SIGNATURE(S) (See Instructions)
TITLE
DATE
SEAL
Preparer’s FEIN, SSN or PTIN
DATE
PREPARER’S SIGNATURE (If other than taxpayer)
PAID
PREPARER
ONLY
FIRM NAME
FIRM ADDRESS
Mail return and payment to: Government of the District of Columbia, Office of Tax and Revenue, 6
th
Floor, 941 North
Capitol St., N.E. Washington, D.C. 20002. Make check or money order payable to the D.C. Treasurer. Include your
Federal Employer ID number (or SSN), “FR-128” and tax year on your payment.
2002 FR-128 P2
Extension of Time to File D.C. Franchise or Partnership Return page 2
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