Form Mo-7004 Draft - Application For Extension Of Time To File - 2010

Enclosure Sequence No. 1120-07 and 1120S-05

FORM

MISSOURI DEPARTMENT OF REVENUE

MO-7004

APPLICATION FOR EXTENSION

OF TIME TO FILE

(REV. 10-2010)

NOTE: IF YOU HAVE AN APPROVED FEDERAL EXTENSION, YOU MAY NOT BE REQUIRED TO FILE THIS FORM. ALSO, YOU MAY NOT BE REQUIRED TO FILE AN EXTENSION

IF YOU DO NOT EXPECT TO OWE ADDITIONAL TAX OR IF YOU ANTICIPATE RECEIVING A REFUND. SEE THE INSTRUCTIONS FOR DETAILS.

CORPORATION NAME

M

M

D

D

Y

Y

DEPARTMENT OF

REVENUE USE ONLY

IN CARE OF NAME (ATTORNEY, GUARDIAN, EXECUTOR, ETC.)

TELEPHONE NUMBER

(__ __ __) __ __ __ -__ __ __ __

NUMBER AND STREET

CITY, STATE, ZIP CODE

TYPE OF RETURN / EXTENSION

(Only one box may be checked below. Separate

TAXPAYER IDENTIFICATION NUMBER

request must be made for each return or report.)

Mail to: MISSOURI DEPARTMENT OF REVENUE, P.O. BOX 3365,

Missouri Tax I.D.

JEFFERSON CITY, MO 65105-3365.

Number

Corporation Income/Franchise Tax Return, Form MO-1120 and

Missouri Charter

Schedule MO-FT

Number

S Corporation Income/Franchise Tax Return, Form MO-1120S and

Schedule MO-FT

Federal I.D. Number

If one of the boxes below is checked, mail to: MISSOURI DEPARTMENT OF

REVENUE, P.O. BOX 898, JEFFERSON CITY, MO 65105-0898.

FILING FEDERAL FORM 1120C OR 990T

Bank Franchise Tax Return, Form INT-2 and INT 2-1

Check the box based on the federal form filed:

Savings and Loan Tax Return, Form INT-3

Form 1120C (Cooperative Association)

Credit Institution Tax Return, Form 2823

Form 990T (Exempt Organization)

Credit Union Tax Return, Form INT-4

YEAR / DATE OF EXTENSION

Income Tax Year Beginning

Income Tax Year Ending

An Extension of Time Until

Check here if you are filing a short period.

TAX PAYMENT SCHEDULE —

THIS SCHEDULE MUST BE COMPLETED (SEE LINE-BY-LINE INSTRUCTIONS ON BACK)

1. Tentative amount of the tax for the taxable year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2. Less

(a) Missouri estimated income tax payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(a)

(b) Overpayment applied as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(b)

(c) Tax credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(c)

(d) Total of Lines 2a through 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(d)

3. Balance due (Line 1 minus Line 2d). Make remittance payable to the MISSOURI DEPARTMENT OF REVENUE.

Before mailing — write your Missouri Tax I.D. Number on your check or money order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

DEPARTMENT OF REVENUE USE ONLY

If you pay by check, you authorize the Department of Revenue to process the check electronically. Any returned check may be presented again electronically.

Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on

all information of which he/she has any knowledge. I declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption,

credit or abatement if I employ such aliens. I also declare that if I am a business entity, I participate in a federal work authorization program with respect to the employees working in connection with any

contracted services, and I do not knowingly employ any person who is an unauthorized alien in connection with any contracted services.

SIGNATURE OF OFFICER

DATE

PREPARER’S SIGNATURE

DATE

__ __ / __ __ /__ __ __ __

__ __ / __ __ /__ __ __ __

TITLE OF OFFICER

DAYTIME TELEPHONE

PREPARER’S ADDRESS AND ZIP CODE

FEIN, SSN, OR PTIN

(_ _ _) _ _ _ - _ _ _ _

__ __ __ __ __ __ __ __ __

SEE “TYPE OF RETURN/EXTENSION” ABOVE FOR MAILING ADDRESS.

MO 860-3012 (10-2010)