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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

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

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