Form Ri-4868 - Rhode Island Application For Automatic Extension Of Time To File A Rhode Island Individual Income Tax Return - 2012

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RI-4868
Rhode Island Application for Automatic Extension of Time To
2012
File a Rhode Island Individual Income Tax Return
PURPOSE OF FORM RI-4868
ADDITIONAL INFORMATION
Use Form RI-4868 to obtain an automatic 6 month extension of
The tax due on the return must be paid on or before April 15,
time to file a Rhode Island Individual Income Tax Return. Form
2013.
RI-4868 can be used to extend the filing of Form RI-1040,
Rhode Island Resident Individual Tax Return, or RI-1040NR,
HOW TO PREPARE YOUR PAYMENT?
Nonresident Income Tax Return.
Make your check or money order payable to the "R.I. Division of
Taxation." Do not send cash. Make sure your name and address
The filing or granting of an extension of time to file does not
appear on your check or money order. Write "Form RI-4868", your
extend the time for payment of tax due on the return.
daytime phone number and the your social security number on your
check or money order.
Filing Form RI-4868 DOES NOT extend the time to file
Form RI-1040H or Form RI-6238. These forms must be
HOW TO SEND IN YOUR RI-4868
filed on or before April 15, 2013 even if you file an
Retain the top portion of this form for your records. Detach and return
extension for Form RI-1040.
the lower portion with your payment. DO NOT staple or otherwise
attach your payment and Form RI-4868 to each other. Instead, just put
EXTENSION OF TIME
them loose in the envelope. Mail your payment and Form RI-4868 to
The Rhode Island extension form need not be filed if you are not
the Rhode Island Division of Taxation, Dept#87, PO Box 9703,
required to make payment with Rhode Island extension form.
Providence, RI 02940-9703.
If you must file a Rhode Island request for extension, you should:
PAYMENT BY CREDIT CARD
1. Prepare the Rhode Island Extension Form RI-4868.
2. Clearly show the full amount properly estimated as Rhode
Island income tax for the year 2012. If a proper estimate is
not made, the extension request will not be considered
valid.
3. File the extension with the Rhode Island Division of
Taxation on or before April 15, 2013.
4. Pay the amount of Rhode Island tax due as calculated on
Form RI-4868 on or before April 15, 2013.
Contact the service provider listed on this page and follow their
5. Be sure to attach a copy of the Form RI-4868 to the front of
instructions. Enter on page 1 of Form RI-1040 or RI-1040NR, in the
the Rhode Island return when it is filed.
upper left corner, the confirmation number you were given at the end
6. Retain the top portion of this form for your records. Detach
of the transaction and the amount of your tax payment (not includ-
and return the lower portion with your payment.
ing the convenience fee).
Date Paid
Check Number
Amount
Telephone: 1-800-2PAY-TAX (1-800-272-9829)
Internet:
$
DETACH EXTENSION AT PERFORATION TO MAIL IN
STATE OF RHODE ISLAND Application for Extension of Time
RI-4868
2012
DIVISION OF TAXATION - DEPT#87 - PO BOX 9703 - PROVIDENCE, RI 02940-9703
APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO FILE RHODE ISLAND INDIVIDUAL INCOME TAX RETURN
1. Name(s)
Enter tentative tax computation
A. Tentative Rhode Island income tax
Address
B. Total tax withheld, payments
RI-4868
City
State
ZIP Code
& credits
C. Balance Due
2. Your social security number
(line A less line B)
3. ENTER
$
Spouse’s social security number, if joint payment
0 0
AMOUNT
ENCLOSED

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