Form Fit-20 - Indiana Financial Institution Tax Return - 2013 Page 7
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8Form FT-ES
Department of Revenue
Indiana Financial Institution Tax Return - Estimated Quarterly Payment
State Form 49410
(R12/8-13)
Due the 20th day of the 4th, 6th, 9th, and 12th months of the tax year.
Name _____________________________________________
(Do Not Write Above)
Address ___________________________________________
__________________________________________________
Federal Identification Number
Signature of Officer
Title
Voucher Number
Calendar or Fiscal Year Ending
Due Date
Date
Daytime Phone #
(E
(Enter 1, 2, 3, or 4)
nter MM-YYYY)
(Enter MM-DD-YYYY)
Financial Institution Tax Due for the Quarter
Enter Total Tax Below:
Indiana Department of Revenue
Pay this amount, with U. S. funds.
100 N. Senate Ave.
Do not send cash.
Indianapolis, IN 46204-2253
Please make check payable to the Indiana Department of Revenue.
Instructions for Form FT-EXT
The extension return, Form FT-EXT, must be used when a payment is due and additional time is necessary for
filing the annual Indiana Financial Institution Tax Return (FIT-20). A penalty for late payment will not be imposed
if at least 90 percent of the tax is paid by the original due date and the remaining balance, plus interest, is paid
in full by the extended due date.
Form FT-EXT
Department of Revenue
State Form 49171
Indiana Financial Institution Tax Return - Extension Payment
(R11/8-13)
Due the 15th day of the 4th month following the close of your tax year.
Name _____________________________________________
(Do Not Write Above)
Address ___________________________________________
__________________________________________________
Signature of Officer
Title
Federal Identification Number
Extension
Calendar or Fiscal Year Ending
Due Date
Date
Daytime Phone #
(E
nter MM-YYYY)
(Enter MM-DD-YYYY)
Payment
Financial Institution Tax Due for the Quarter
Enter Total Tax Below:
Indiana Department of Revenue
Pay this amount, with U. S. funds.
100 N. Senate Ave.
Do not send cash.
Indianapolis, IN 46204-2253
Please make check payable to the Indiana Department of Revenue.
*24100000000*
24100000000
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