Form 1027 - Application For Automatic Extension Of Time To File A Delaware Individual Income Tax Return - 2012

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DO NOT WRITE IN THIS BOX
DELAWARE
TAX YEAR
Reset
FORM 1027
2012
Print Form
001-26
APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO
FILE A DELAWARE INDIVIDUAL INCOME TAX RETURN
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THE AMOUNT SHOWN ON LINE 6 BELOW. ATTACH THE DUPLICATE TO YOUR DELAWARE PERSONAL INCOME TAX RETURN.
NAME, (IF JOINT RETURN, GIVE FIRST NAMES AND INITIALS OF BOTH)
LAST NAME
YOUR SOCIAL SECURITY NUMBER
PLEASE
PRINT
PRESENT HOME ADDRESS (NUMBER & STREET, INCLUDING APT. NUMBER OR RURAL ROUTE)
SPOUSE’S SOCIAL SECURITY NUMBER
OR
TYPE
CITY, TOWN OR POST OFFICE
STATE
ZIP CODE
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THE
TAXABLE YEAR BEGINNING
, 20
).
1. TOTAL INCOME TAX LIABILITY YOU EXPECT TO OWE FOR 2012....................................................................
2. DELAWARE INCOME TAX WITHHELD....................................................
3. TAX YEAR 2012 ESTIMATED TAX PAYMENTS (INCLUDE PRIOR
YEARS OVERPAYMENT ALLOWED AS A CREDIT)...............................
4. OTHER PAYMENTS & CREDITS..............................................................
5. TOTAL (ADD LINES 2, 3, AND 4)..............................................................................................................................
6. BALANCE DUE (SUBTRACT LINE 5 FROM LINE 1). PAY IN FULL WITH THIS APPLICATION
........................................................................................................................................................BALANCE DUE>
SIGNATURE AND VERIFICATION
IF PREPARED BY TAXPAYER:
UNDER PENALTY OF PERJURY, I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE
STATEMENTS MADE HEREIN ARE TRUE AND CORRECT.
YOUR SIGNATURE
DATE
DAYTIME PHONE N0.
SPOUSE’S SIGNATURE
DATE
DAYTIME PHONE NO.
(IF FILING JOINTLY, BOTH MUST SIGN EVEN IF ONLY ONE HAD INCOME)
IF PREPARED BY SOMEONE OTHER THAN TAXPAYER:
UNDER PENALTIES OF PERJURY, I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE
STATEMENTS MADE HEREIN ARE TRUE AND CORRECT, THAT I AM AUTHORIZED BY THE TAXPAYER TO PREPARE
THIS APPLICATION, AND THAT I AM:
A MEMBER IN GOOD STANDING OF THE BAR OF THE HIGHEST COURT OF (SPECIFY JURISDICTION)....
A CERTIFIED PUBLIC ACCOUNTANT DULY QUALIFIED TO PRACTICE IN (SPECIFY JURISDICTION)..........
A PERSON ENROLLED TO PRACTICE BEFORE THE INTERNAL REVENUE SERVICE
A DULY AUTHORIZED AGENT HOLDING A POWER OF ATTORNEY WITH RESPECT TO FILING AN EXTENSION OF TIME. (THE POWER OF ATTORNEY NEED
NOT BE SUBMITTED UNLESS REQUESTED)
A PERSON STANDING IN CLOSE PERSONAL BUSINESS RELATIONSHIP TO THE TAXPAYER, WHO IS
UNABLE TO SIGN THIS APPLICATION BECAUSE OF ILLNESS, ABSENCE, OR OTHER GOOD CAUSE. MY
RELATIONSHIP TO THE TAXPAYER AND THE REASON WHY THE TAXPAYER IS UNABLE TO SIGN THIS
APPLICATION ARE:
YOUR SIGNATURE
DATE
DAYTIME PHONE N0.
SEE INSTRUCTIONS ON REVERSE SIDE
*DF64212019999*

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