Form 1127-A - Application For Extension Of Time For Payment Of Income Tax For 2011 Due To Undue Hardship - 2011 Page 3
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Form 1127-A (2011)
Page
Where To File
Section references are to the Internal Revenue Code.
Mail Form 1127-A to the address shown below that applies to you.
General Instructions
Do not attach this form to your return or mail it to the address for
your tax return.
Purpose of Form
Use Form 1127-A to ask for an extension of time to pay the income
IF you live in . . .
THEN mail Form 1127-A to . . .
tax due, or to be shown as due, on your Form 1040, Form 1040A, or
Alabama, Alaska, Arizona,
Internal Revenue Service
Form 1040EZ for 2011. See Who Should File, next, to determine if
Arkansas, Colorado, Connecticut,
P.O. Box 480
you are eligible to use this form. The granting of this request for an
Delaware, District of Columbia,
Stop 662-X
extension of time to pay will only result in relief from the failure-to-
Hawaii, Idaho, Indiana, Iowa,
Holtsville, NY 11742-0480
pay penalty and only if the tax, interest, and any other penalties are
Kansas, Kentucky, Louisiana,
fully paid by October 15, 2012.
Maine, Maryland, Massachusetts,
Minnesota, Mississippi, Missouri,
▲
Form 1127-A does not extend the time to file your 2011
!
Montana, Nebraska, Nevada, New
income tax return. To get an extension of time to file, you
Hampshire, New Jersey, New
must file Form 4868, Application for Automatic Extension
Mexico, New York, North Dakota,
CAUTION
of Time To File U.S. Individual Income Tax Return.
Oklahoma, Oregon, Pennsylvania,
Future developments. The IRS has created a page on IRS.gov for
Rhode Island, South Carolina,
information about Form 1127-A and its instructions at
South Dakota, Tennessee, Utah,
form1127. Information about future developments affecting Form
Vermont, Virginia, Washington,
1127-A (such as legislation enacted after we release it) will be
West Virginia, Wisconsin,
posted on that page.
Wyoming
Who Should File
California, Florida, Georgia, Illinois,
Internal Revenue Service
Michigan, North Carolina, Ohio,
P.O. Box 24035
You are eligible for an extension of time to pay your income tax for
Texas
Stop 81208
2011 if you meet the following requirements:
Fresno, CA 93779-4035
1. Your income tax liability for 2011, as shown or to be shown on
your Form 1040, 1040A, or 1040EZ, is less than $50,000.
A foreign country, U.S. possession
Internal Revenue Service
or territory, or use an APO or FPO
5000 Corporate Dr.
2. Your adjusted gross income, as shown or to be shown on your
address.
Holtsville, NY 11742
Form 1040, 1040A, or 1040EZ, is less than—
a. $100,000, if your filing status is single, married filing
Extension Period
separately, head of household, or qualifying widow(er), or
The extension of time to pay your income tax liability is conditioned
b. $200,000, if you are filing a joint return.
upon your paying the full amount of tax, interest, and penalties
3. You are experiencing economic hardship and need a six-month
(other than the failure-to-pay penalty) due on or before the October
extension of time to pay your income tax for 2011 because—
15, 2012, extension date. The granting of this request for an
a. You were or your spouse (if filing a joint return) was
extension of time to pay will only result in relief from the
unemployed for at least 30 consecutive days during 2011 or
failure-to-pay penalty.
2012, prior to April 15, 2012, or
Note. The IRS will notify you only if your application is not
b. You are self-employed and you suffered a 25% or greater
approved.
reduction in business income in 2011 (relative to 2010) due
Payment Due Date
to the economic downturn.
Note. If you are requesting to postpone payment of tax shown on a
You must pay in full all tax, interest, and penalties (other than the
failure-to-pay penalty) on or before October 15, 2012. Do not wait
return (other than a tax shown on Form 1040, 1040A, or 1040EZ) or
to receive a bill from the IRS.
an amount determined as a deficiency, see Form 1127.
Interest. You will owe interest on any tax not paid by April 15, 2012,
When To File
regardless of whether an extension of time to pay the tax has been
Your Form 1127-A must be postmarked on or before April 17, 2012.
obtained. The interest runs until you pay the tax.
Penalties. If you fail to pay the full amount of all tax, interest, and
penalties (other than the failure-to-pay penalty) on or before
October 15, 2012, the penalty for failure to pay will be imposed as
of the original payment due date (April 15, 2012).
Specific Instructions
Name, Address, and Social Security Number
Enter your name, address, and social security number (SSN) or
individual taxpayer identification number (ITIN). If this application is
for the tax shown on a joint return, include both spouses’ names in
the order in which they appear or will appear on your return.
P.O. box. Enter your box number only if your post office does not
deliver to your street address.
Foreign address. If you have a foreign address, enter the city name
on the appropriate line. Do not enter any other information on that
line, but also complete the spaces below that line. Do not
abbreviate the country name. Follow the country's practice for
entering the postal code and the name of the province, county, or
state.
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