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DELAWARE

FORM 1027

TAX YEAR

(REV. CODE 001)

APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO

FILE A DELAWARE INDIVIDUAL INCOME TAX RETURN

NOTE: PREPARE THIS FORM IN DUPLICATE. FILE THE ORIGINAL WITH THE DIVISION OF REVENUE, STATE OF DELAWARE ON OR BEFORE THE DUE DATE AND PAY

THE AMOUNT SHOWN ON LINE 6 BELOW. ATTACH THE DUPLICATE TO YOUR DELAWARE PERSONAL INCOME TAX RETURN.

NAME, (IF JOINT RETURN, GIVE FIRST NAMES AND INITIALS OF BOTH)

LAST NAME

YOUR SOCIAL SECURITY NUMBER

PLEASE

PRESENT HOME ADDRESS (NUMBER & STREET, INCLUDING APT. NUMBER OR RURAL ROUTE)

SPOUSE'S SOCIAL SECURITY NUMBER

TYPE

CITY, TOWN OR POST OFFICE

STATE

ZIP CODE

AN AUTOMATIC EXTENSION OF TIME UNTIL AUGUST 15, 20_____ IS HEREBY REQUESTED IN WHICH TO FILE A DELAWARE PERSONAL INCOME

TAX RETURN FOR THE CALENDAR YEAR 20_____ (OR IF A FISCAL YEAR RETURN UNTIL ___________________________, 20_____ FOR THE

TAXABLE YEAR BEGINNING________________________________________________ , 20_____).

1. TOTAL INCOME TAX LIABILITY YOU EXPECT TO OWE FOR 20______...............................................................

2. DELAWARE INCOME TAX WITHHELD..........................................................

TAX YEAR 20_____ ESTIMATED TAX PAYMENTS (INCLUDE PRIOR

YEARS OVERPAYMENT ALLOWED AS A CREDIT).....................................

OTHER PAYMENTS & CREDITS...................................................................

5. TOTAL (ADD LINES 2, 3, AND 4)................................................................................................................................

6. BALANCE DUE (SUBTRACT LINE 5 FROM LINE 1). PAY IN FULL WITH THIS APPLICATION

..........................................................................................................................................................BALANCE DUE>

SIGNATURE AND VERIFICATION

IF PREPARED BY TAXPAYER: UNDER PENALTY OF PERJURY, I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE

STATEMENTS MADE HEREIN ARE TRUE AND CORRECT.

YOUR SIGNATURE

DATE

SPOUSE'S SIGNATURE

DATE

(IF FILING JOINTLY, BOTH MUST SIGN EVEN IF ONLY ONE HAD INCOME)

IF PREPARED BY SOMEONE OTHER THAN TAXPAYER:

UNDER PENALTIES OF PERJURY, I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE

STATEMENTS MADE HEREIN ARE TRUE AND CORRECT, THAT I AM AUTHORIZED BY THE TAXPAYER TO PREPARE

THIS APPLICATION, AND THAT I AM:

A MEMBER IN GOOD STANDING OF THE BAR OF THE HIGHEST COURT OF (SPECIFY JURISDICTION)....

A CERTIFIED PUBLIC ACCOUNTANT DULY QUALIFIED TO PRACTICE IN (SPECIFY JURISDICTION)..........

A PERSON ENROLLED TO PRACTICE BEFORE THE INTERNAL REVENUE SERVICE

A DULY AUTHORIZED AGENT HOLDING A POWER OF ATTORNEY WITH RESPECT TO FILING AN EXTENSION OF TIME. (THE POWER OF ATTORNEY NEED

NOT BE SUBMITTED UNLESS REQUESTED)

A PERSON STANDING IN CLOSE PERSONAL BUSINESS RELATIONSHIP TO THE TAXPAYER, WHO IS

UNABLE TO SIGN THIS APPLICATION BECAUSE OF ILLNESS, ABSENCE, OR OTHER GOOD CAUSE. MY

RELATIONSHIP TO THE TAXPAYER AND THE REASON WHY THE TAXPAYER IS UNABLE TO SIGN THIS

APPLICATION ARE:

YOUR SIGNATURE

DATE

SEE INSTRUCTIONS ON REVERSE SIDE

Delaware Form 1027 - Application For Automatic Extension Of Time To File A Delaware Individual Income Tax Return

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