Fillable Form 921 - Consent To Extend The Time To Assess Income Tax (Page 2 of 2) in pdf

Instructions for Taxpayer(s)

Please sign and return the original and copy of Form 921, Consent to Extend the Time to Assess Income Tax, to apply

for an extension in accordance with Revenue Procedure 92-29 and its successors. Your signature(s) must match the

name(s) as it appears on this form.

If this consent form includes tax years where a joint return was filed, the signature of both husband and wife is required.

One spouse may sign as agent for the other, if acting under an authorized power of attorney.

If you're an attorney or agent for the taxpayer(s), you may sign the consent form provided the action is specifically

authorized by a power of attorney. If you haven't filed a power of attorney, please include it with this form.

If you're acting as a fiduciary (executor, administrator, trustee, etc.) you must include a completed Form 56, Notice

Concerning Fiduciary Relationship, if you haven't already filed one.

If the taxpayer named on this consent form is a corporation, the officer(s) duly authorized to sign on behalf of the entity

must sign the consent. Include the name of the corporation and signature/ title of the corporate officer(s).

If you're an entity subject to the unified audit and litigation procedures for TEFRA (Tax Equity and Fiscal

Responsibility Act) partnerships, you must use Form 921-P. If you're an entity not subject to the TEFRA

requirements (namely S-Corporations, partnerships, limited liability companies, trusts, syndicates, pools, etc.), you must

use Form 921-I.

Instructions for Internal Revenue Service Employees

The signature and title line must be signed and dated by the appropriate authorized official within your division.

SMALL BUSINESS/SELF-EMPLOYED DIVISION

Enter the name and title of your business unit executive (e.g., Area Director; Director, Compliance Policy; or Director,

Compliance Services). Secure signature of authorized division official.

WAGE AND INVESTMENT DIVISION

Enter the name and title of your business unit executive (e.g., Area Director or Director, Field Compliance Services).

Secure signature of authorized division official.

LARGE AND MID-SIZE BUSINESS ENTITIES DIVISION

Enter the name and title of your business unit executive (e.g., Director, Field Compliance). Secure signature of

authorized division official.

TAX EXEMPT AND GOVERNMENT ENTITIES DIVISION

Enter the name and title of your business unit executive (e.g., Director, Exempt Organizations; Director, Employee

Plans; Director, Federal, State and Local Governments; Director, Indian Tribal Governments; or Director, Tax Exempt

Bonds). Secure signature of authorized division official.

APPEALS DIVISION

Enter the name and title of your business unit executive (e.g., Director, Appeals Operating Unit). Secure signature of

authorized division official.

921 (

Form

Rev. 07-2001)

Catalog Number 16974D

Form 921 - Consent To Extend The Time To Assess Income Tax Page 2