2350
Application for Extension of Time
OMB No. 1545-0074
To File U.S. Income Tax Return
Form
2017
For U.S. Citizens and Resident Aliens Abroad Who Expect To Qualify for Special Tax Treatment
See instructions on page 3.
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Department of the Treasury
Go to for the latest information.
Internal Revenue Service
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Please
Your first name and initial
Last name
Your social security number
print or
type.
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions.
City, town or post office, state, and ZIP code. If you have a foreign address, enter only the city name on this line;
File by
then complete the spaces below (see instructions).
the due
date for
filing
Foreign country name
Foreign province/county
Foreign postal code
your
return.
Please fill in the Return Label at the bottom of this page.
1
I request an extension of time until
to file my income tax return for the calendar year 2017,
or other tax year ending
, because my tax home is in a foreign country and I expect to qualify
for special tax treatment by meeting the “bona fide residence test” or the “physical presence test” (see instructions).
2
Yes
No
Were you previously granted an extension of time to file for this tax year? .
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3
Yes
No
Will you need additional time to allocate moving expenses? .
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4a Date you first arrived in the foreign country
b Date qualifying period begins
; ends
c Your foreign home address
d Date you expect to return to the United States
Note: This is not an extension of time to pay tax. Full payment is required to avoid interest and late payment charges.
5
Enter the amount of income tax paid with this form .
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5
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Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete; and, if prepared by someone other than the taxpayer, that I am authorized to prepare this form.
Signature of taxpayer
Date
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Signature of spouse
Date
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Signature of preparer
Date
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other than taxpayer
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Please fill in the Return Label below. The IRS will complete the Notice to Applicant and return it to you. If you want it sent to another address or to an
agent acting for you, enter the other address and add the agent’s name.
(Do not detach)
We have approved your application.
Notice to
We have not approved your application.
Applicant
However, we have granted a 45-day grace period to
. This grace period is
considered a valid extension of time for elections otherwise required to be made on a timely return.
We have not approved your application. After considering the above information, we cannot grant your
request for an extension of time to file. We are not granting a 45-day grace period.
To Be
We cannot consider your application because it was filed after the due date of your return.
Completed
Other
by the IRS
Director
Date
Taxpayer’s name (and agent’s name, if applicable). If a joint return, also give spouse’s name.
Address (number and street, including suite, room, or apt. no., or P.O. box number)
City or town, province or state, and country (including postal or ZIP code)
Agents:
Always include taxpayer’s name on Return Label.
2350
For Privacy Act and Paperwork Reduction Act Notice, see page 4.
Form
(2017)
Cat. No. 11780H