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Form Bc-4868 - Application For Automatic Extension Of Time To File An Individual Income Tax Return - 2012

CITY OF BATTLE CREEK

BC-4868

2012

APPLICATION FOR AUTOMATIC EXTENSION OF TIME

TO FILE AN INDIVIDUAL INCOME TAX RETURN

4/30/2013, the due date of the return for the 2012 tax year

Date to file by:

Payment:

Make payment by check or money order payable to "City of Battle Creek" include your SSN,

Payment Method:

Daytime phone number, and 2012 Form BC-4868 on your check or money order. DO NOT

SEND CASH.

CITY OF BATTLE CREEK

Address for Payment:

P O BOX 1657, BATTLE CREEK, MI 49016-1657

An extension to file does not extend the time to pay the tax due.

Other Instructions:

The extension is automatically granted upon payment of the tentative tax balance due.

Failure to pay the balance due (the tentative tax due) invalidates the extension request.

An extension filed without a payment will not be accepted.

The City Income tax Ordinance limits the extension of time for filing annual returns to SIX

months for the original due date.

The filing of federal Form 4868, Application for Automotive Extension of time to file U.S.

Individual Income Tax return, with the Internal Revenue Service, does not grant an extension of

time to file a city return.

Where the Federal Internal Revenue Code grants an automatic two-month extension to persons

living outside the United States, an automatic two-month extension will be granted.

Taxpayer Records:

Amount Paid:

Check Number:

Date Mailed:

DETACH HERE

CITY OF BATTLE CREEK

BC-4868

2012

APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO FILE AN INDIVIDUAL INCOME TAX RETURN

Taxpayers' first name, Initial, last name

Taxpayer's SSN

If joint return, spouse's first name, Initial, last name

Spouse's SSN

Present home address (Number and street)

Apt no.

1. Estimated total tax liability for 2012

Address line 2 (P.O. address for mailing use only)

2. Total 2012 payments

State

Zip code

3. Tentative tax balance due.

City, town or post office

(Subtract line 2 from line 1)

Foreign country name, province/county, postal code

4. Amount you are paying by

check or money order

Form Bc-4868 - Application For Automatic Extension Of Time To File An Individual Income Tax Return - 2012

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