Arizona Form 204 - Application For Filing Extension For Individual Returns Only - 2013
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1FOR
ARIZONA FORM
Application for Filing Extension
CALENdAR yEAR
204
2013
For Individual Returns Only
66
m m d d
2 0 1 3 and ending
m m d d y y y y
For the calendar year 2013 or fiscal year beginning
.
your First Name and middle Initial
Last Name
your Social Security No.
Enter
1
your
If a joint return, Spouse’s First Name and middle Initial
Last Name
Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route
Apt. No.
daytime Phone (with area code)
2
94
City, Town or Post Office
State
ZIP Code
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
3
88
Resident Personal Income Tax Forms – Check only one box:
140
140A
140EZ
140PTC
140ET
Part-year Resident Personal Income Tax, Form 140Py
81 PM
80 RCVD
Nonresident Personal Income Tax, Form 140NR
All extension requests must be postmarked on or before
An Arizona extension cannot be granted for more than
the original due date of the return, unless the original due
six months beyond the original due date of the return.
date falls on a Saturday, Sunday, or legal holiday. In that
Arizona will grant an automatic six-month extension to
case, your request must be postmarked on or before the
individuals filing Forms 140, 140A, 140EZ, 140NR, 140PY,
business day following that Saturday, Sunday, or legal
140PTC or 140ET. Arizona will accept a valid federal
holiday. If you are a calendar year filer, your request for
extension for the period covered by the federal extension.
a 2013 filing extension must be postmarked on or before
This includes the automatic six-month individual federal
April 15, 2014.
filing extension.
CHECK ONE BOX:
Fiscal Tax Year Ending
Return Due Date
Individual Calendar Year Filers:
(filing Forms 140, 140A, 140EZ, 140NR, 140Py, 140PTC or 140ET)
October 15, 2014
This is a request for an automatic 6-month filing extension ..................................
Individual Fiscal Year Filers:
(automatic 6-month extension period)
m m d d y y y y m m d d y y y y
Enter taxable year-end date and 6-month extended due date ..............................
A federal extension will be used to file this tax return. This form is being used to transmit the Arizona extension payment.
00
1 Tax liability for 2013. you may estimate this amount ......................................................................................
1
00
2 Arizona income tax withheld during 2013 ...................................................................... 2
00
3 Arizona estimated tax payments for 2013 ..................................................................... 3
00
4 Credits you will claim on your 2013 return. See Form 301 for a list of credits .............. 4
00
5 Add lines 2 through 4 .......................................................................................................................................
5
00
6 Balance of Tax: Subtract line 5 from line 1 ....................................................................................................
6
00
7 Enter the amount of payment. Round your payment to the nearest dollar .....................................................
7
• Make check payable to Arizona Department of Revenue and write your SSN and tax year on your payment.
• Attach your payment to the upper left corner of this page.
• IMPORTANT: If you are filing under a federal extension but are making an Arizona extension payment by credit card
or electronic payment, do not mail Form 204 to us. We will apply your extension tax payment to your account.
• If you are sending a payment with this request, mail to Arizona Department of Revenue,
PO Box 29085, Phoenix, AZ 85038-9085.
• If you are not sending a payment with this request, mail to Arizona Department of Revenue,
PO Box 52138, Phoenix, AZ 85072-2138.
AdOR 10576 (13)
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