Arizona Form
Application for Filing Extension
FOR CALENDAR YEAR
2015
141AZ EXT
For Fiduciary Returns Only
66
For the calendar year 2015 or fiscal year beginning
M M D D
2 0 1 5 and ending
M M D D Y Y Y Y
.
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.
88
3
City, Town or Post Office
State
ZIP Code
4
Daytime Phone Number of Fiduciary/Representative – include area code
81 PM
80 RCVD
All extension requests must be postmarked on or before
Arizona will grant an automatic five-month extension
the original due date of the return, unless the original due
to fiduciaries filing Form 141AZ.
Arizona will accept a
date falls on a Saturday, Sunday, or legal holiday.
In
valid federal extension for the period covered by the
that case, your request must be postmarked on or before
federal extension. This includes the automatic five-month
the business day following that Saturday, Sunday, or legal
fiduciary federal filing extension.
holiday. If you are a calendar year filer, your request for
a 2015 filing extension must be postmarked on or before
April 18, 2016.
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 15, 2016
Fiduciary Fiscal Year Filers:
(automatic 5-month extension period)
Enter taxable year-end date and 5-month extended due date ..............................
M M D D Y Y Y Y M M D D Y Y Y Y
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 2015. You may estimate this amount ..................................................................... 1
00
2 Arizona estimated tax payments for 2015 ...................................................................................... 2
00
3 Balance of Tax: Subtract line 2 from line 1 .................................................................................. 3
00
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 and 2015 extension on the payment.
•
• Include the payment with Form 141AZ EXT.
• 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 11136 (15)
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