Arizona Form 120ext Draft - Application For Automatic Extension Of Time To File Corporation, Partnership, And Exempt Organization Returns - 2009

Application for Automatic Extension of Time to File

ARIZONA FORM

2009

Corporation, Partnership, and Exempt Organization Returns

120EXT

M M D D Y Y Y Y

M M D D Y Y Y Y

For the calendar year 2009 or fi scal year beginning

and ending

.

CHECK ONE:

Check box if: This is the fi rst tax return fi led under this name and EIN

Name, address, or EIN has changed

Calendar year

Fiscal year

If EIN has changed, list prior number

Employer identifi cation number (EIN)

Name

Please

Business telephone number

Type

Number and street or PO Box

or

(

)

City, or town, state, and ZIP code

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Print

Check type of return to be fi led:

Form 120

Form 120A

Form 120S

Form 99T

Form 99

Form 165

All applications for an extension of time to fi le must be postmarked on or before the original due

date of the return, unless the original due date falls on Saturday, Sunday, or a legal holiday. In that

case, the application must be postmarked on or before the business day following such Saturday,

Sunday, or legal holiday.

S corporations and partnerships: Use Form 204 to request an extension of time to fi le a composite

return for nonresident individual shareholders or nonresident individual partners on Form 140NR.

81

66

AN ARIZONA EXTENSION CANNOT BE GRANTED FOR MORE THAN SIX MONTHS BEYOND THE ORIGINAL DUE DATE OF THE RETURN. ARIZONA WILL

ACCEPT A VALID FEDERAL EXTENSION FOR THE SAME PERIOD OF TIME COVERED BY THE FEDERAL EXTENSION. THE FEDERAL EXTENSION FOR

PARTNERSHIPS IS FIVE MONTHS FOR RETURNS DUE ON OR AFTER JANUARY 1, 2009.

Check one:

Form 120, Form 120A, Form 120S, Form 99T, Form 99: This is a request for an automatic six-month extension of time until ______/______/________,

MM

MM

DD

DD

YYYY

YYYY

to fi le the tax return for the taxable year ending ______/______/________.

MM

MM

DD

DD

YYYY

YYYY

Form 165 only: This is a request for an automatic fi ve-month extension of time until ______/______/________, to fi le the tax return

MM

MM

DD

DD

YYYY

YYYY

for the taxable year ending ______/______/________.

MM

MM

DD

DD

YYYY

YYYY

A federal extension will be used to fi le this tax return. This form is being used to transmit the Arizona extension payment.

Extension Payment Computation (For Forms 120, 120A, 120S, and 99T only)

1 Amount of tax for the taxable year. See instructions .......................................................................................................................

1

00

2 Less estimated tax payments ..........................................................................................................................................................

2

00

3 Balance of tax - line 1 minus line 2 ..................................................................................................................................................

3

00

4 Enter amount of payment enclosed. See instructions ..............................................................................PAYMENT ENCLOSED

4

00

Make check payable to:

ARIZONA DEPARTMENT OF REVENUE

Send application and payment to:

Arizona Department of Revenue, PO Box 29079, Phoenix AZ 85038-9079

THE TAXPAYER WILL BE LIABLE FOR THE EXTENSION UNDERPAYMENT PENALTY IF AT LEAST 90 PERCENT OF THE TAX LIABILITY DISCLOSED BY THE

RETURN HAS NOT BEEN PAID BY THE ORIGINAL DUE DATE OF THE RETURN. TAXPAYERS SUBJECT TO THE EXTENSION UNDERPAYMENT PENALTY

ARE NOT SUBJECT TO THE LATE PAYMENT PENALTY PRESCRIBED BY A.R.S. §2-1125(D). INTEREST ACCRUES ON ANY ADDITIONAL TAX DUE FROM

THE ORIGINAL DUE DATE OF THE RETURN UNTIL PAID.

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 that I am authorized to prepare this form.

Signature of offi cer or agent

Title

Date

(

)

Printed Name

Business Phone Number

Agent’s TIN

ADOR 91-0028 (09)

DRAFT 09-09-09.

DRAFT 09-09-09.