Form 8868 - Application For Extension Of Time To File An Exempt Organization Return Page 2
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Form 8868 (Rev. 1-2013)
Page
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box .
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Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.
• If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
Part II
Additional (Not Automatic) 3-Month Extension of Time. Only file the original (no copies needed).
Enter filer's identifying number, see instructions
Name of exempt organization or other filer, see instructions.
Employer identification number (EIN) or
Type or
print
Number, street, and room or suite no. If a P.O. box, see instructions.
Social security number (SSN)
File by the
due date for
filing your
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
return. See
instructions.
Enter the Return code for the return that this application is for (file a separate application for each return)
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Application
Return
Application
Return
Is For
Code
Is For
Code
Form 990 or Form 990-EZ
01
Form 990-BL
02
Form 1041-A
08
Form 4720 (individual)
03
Form 4720
09
Form 990-PF
04
Form 5227
10
Form 990-T (sec. 401(a) or 408(a) trust)
05
Form 6069
11
Form 990-T (trust other than above)
06
Form 8870
12
STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
• The books are in the care of
▶
Telephone No.
FAX No.
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• If the organization does not have an office or place of business in the United States, check this box .
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• If this is for a Group Return, enter the organization’s four digit Group Exemption Number (GEN)
. If this is
for the whole group, check this box
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. If it is for part of the group, check this box .
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and attach a
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list with the names and EINs of all members the extension is for.
4
I request an additional 3-month extension of time until
, 20
.
5
For calendar year
, or other tax year beginning
, 20
, and ending
, 20
.
6
If the tax year entered in line 5 is for less than 12 months, check reason:
Initial return
Final return
Change in accounting period
7
State in detail why you need the extension
8 a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions.
8a $
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit and any
amount paid previously with Form 8868.
8b $
c Balance due. Subtract line 8b from line 8a. Include your payment with this form, if required, by using EFTPS
(Electronic Federal Tax Payment System). See instructions.
8c $
Signature and Verification must be completed for Part II only.
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.
Title
Signature
Date
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8868
Form
(Rev. 1-2013)
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