FOR
ARIZONA FORM
CALENDAR YEAR
141AZ EXT
2011
Application for Filing Extension
For Fiduciary Returns Only
66
M M D D Y Y Y Y
M M D D Y Y Y Y
OR FISCAL YEAR BEGINNING
AND ENDING
.
Print Name of Estate or Trust
Employer Identification Number (required)
1
Print Name and Title of Fiduciary
2
Address of Fiduciary - number and street, or rural route
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
3
City, Town or Post Office
State
Zip Code
4
Daytime Phone Number of Fiduciary/Representative – include area code
88
1 Check box 1 if you are a first time Arizona income tax return filer .....
1
81
80
All extension requests must be postmarked on or before
Arizona will grant an automatic five-month extension to
the original due date of the return, unless the original due
fiduciaries filing Form 141AZ. Arizona will accept a valid
date falls on a Saturday, Sunday, or legal holiday. In that
federal extension for the period covered by the federal
case, your request must be postmarked on or before the
extension.
This includes the automatic five-month
business day following that Saturday, Sunday, or legal
fiduciary federal filing extension.
holiday. If you are a calendar year filer, your request for
a 2011 filing extension must be postmarked on or before
April 17, 2012.
CHECK ONE BOX:
Fiscal Tax Year Ending
Return Due Date
Fiduciary Calendar Year Filers:
(filing Form 141AZ)
This is a request for an automatic 5-month filing extension ..................................
September 17, 2012
Fiduciary Fiscal Year Filers:
(automatic 5-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 5-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.
1 Tax liability for 2011. You may estimate this amount ..................................................................
1
00
2 Arizona estimated tax payments for 2011 ....................................................................................
2
00
00
3 Balance of Tax: Subtract line 2 from line 1 ................................................................................
3
4 Enter the amount of payment. Round your payment to the nearest dollar .................................
4
00
Make check payable to Arizona Department of Revenue.
•
Write the estate’s or trust’s EIN on the payment.
•
• Attach the payment to the upper left corner of this page.
• 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.
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ADOR 11136 (11)