DELAWARE DIVISION OF REVENUE
1100PE 9201
FORM 1100-P-EXT
– DELAWARE “S” CORPORATION REQUEST FOR EXTENSION
FEDERAL IDENTIFICATION NUMBER
CALENDAR OR FISCAL YEAR ENDING
DUE ON OR BE FORE
VOUCHER
EXTENSION TO
0-000000000-000
12-31-12
04-01-13
10-01-13
P-5
Reset
00932505000000000000012311204011300000000000000000000
Print Form
BUSINESS MAILING NAME AND ADDRESS
Check Here If A
Request For
Change Form
Is
BALANCE DUE FROM LINE 3
Being Filed
$
0 0
OF WORKSHEET
( BALANCE OF TAX DUE FOR THE YEAR)
Mail This Form With Remittance Payable To:
Delaware Division of Revenue
P.O. Box 8751, Wilmington, DE 19899-8751
CHANGES MUST BE MADE ON THE REQUEST FOR CHANGE FORM.
CHECK THE BOX IF YOU ARE FILING A CHANGE FORM.
AUTHORIZED SIGNATURE I declare under penalties of perjury, that this
DATE
TELEPHONE NUMBER
If desired, provide an e-mail address where we may
is a true, correct and complete return.
contact you regarding this return.
(Cut Coupon on Line Above)
TAXPAYERS WORKSHEET AND RECORD OF PAYMENTS
CALCULATION OF ESTIMATED TAX DUE
1. Estimated amount of distributive income for the taxable year.
$
.00
2a. Total percentage of stock owned by non-resident shareholders. X
.
2b. Multiply Line 1 by Line 2a and enter result on Line 2b.
$
.00
3a. Enter the corporation’s apportionment percentage.
X
.
3b. Multiply Line 2b by Line 3a and enter result on Line 3b.
$
.00
4. Multiply Line 3b by 5.95% and enter the result on Line 4.
(This is the total amont of personal income tax required to be
$
.00
paid on behalf of the non-resident shareholders.)
5. Actual tax liability for the year.
$
.00
6. Estimated tax paid.
$
.00
7. Amount Due with Extension.
$
.00
8. Check Number.
9. Date Paid.
Please fill in the federal identification number, business name and address in the spaces provided. Sign
and date the tax return and supply a telephone number where we can contact someone regarding the
information on the tax return.
PLEASE NOTE: Voucher 1 (T-1) is due the 1st day of the 4th month following the end of the year.
Voucher 2 (T-2) is due the 15th day of the 6th month following the end of the year.
Voucher 3 (T-3) is due the 15th day of the 9th month following the end of the year.
Voucher 4 (T-4) is due the 15th day of the 12th month following the end of the year.