Form 504-I - Application For Extension Of Time To File An Oklahoma Income Tax Return For Individuals - 2016

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ITE

Application for Extension

of Time to File an Oklahoma Income Tax Return

504-I

for Individuals

(This is NOT an extension of time for payment of tax. Corporations, Partnerships and Trust use Form 504-C)

(See Instructions)

Your first name, middle initial and last name

Your Social

Security Number:

If joint return, spouse’s first name, middle initial and last name

Spouse’s Social

Security Number:

Mailing address (number and street, including apartment number or rural route)

City, State and ZIP

Important:

Extension is valid only if 90% of the tax liability is paid by the original due date.

An Extension of Time to File with the IRS has been granted to:

DATE __________________

Extension of Time to File with the Okla. Tax Commission is requested to:

DATE __________________

Oklahoma Income Tax Computation

1. Total income tax liability (you may estimate this amount) .........................................

Note: You must enter an amount on line 1. If you do not expect to owe tax, enter zero.

2. Oklahoma income tax withheld ..............................................

3. Estimated tax payments (include prior year overpayment

allowed as a credit) ................................................................

4. Other payments and credits you expect to claim

on your return ........................................................................

5. Add lines 2, 3 and 4 ..................................................................................................

6. Income tax balance due (subtract line 5 from line 1) ................................................

7. Amount you are paying. Important: Extension is valid only if 90% of the income

tax liability is paid by the original due date ...............................................................

Signature

Under penalty of perjury, I declare that the information contained in this document, attachments and schedules are true and correct to the best of my knowledge and belief.

Your Signature

Date

Spouse’s Signature (if filing jointly, BOTH must sign even if only one had income)

Date

Paid Preparer’s Signature

Date

Return with your payment, if applicable, to: Oklahoma Tax Commission • Income Tax • P.O. Box 26890 •

Oklahoma City, OK 73126-0890.