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Application For Extension Request Form - Ohio 2002 Annual Statement Of Gross Receipts

Application for Extension Request

Ohio 2002 Annual Statement of Gross Receipts

(Call (614) 466-7371 with any questions)

Company Name:

Company FEIN:

Person Req. Ext.

Date:

Fax Number:

(must provide for confirmation)

The above referenced public utility requests an extension for the filing of its Annual Statement of Gross

Receipts for a period of:

15 Days

30 Days

45 Days***

60 Days***

***An extension beyond 30 days must provide an extenuating reason in the space provided below.

Extenuating Reason(s):

An extension can only be granted if our office receives the request by August 1, 2002. Confirmation of the

extension will be sent via the fax number provided above within two business days of receipt (mailed if a

fax number is not provided.)

Fax the extension request to the Public Utility Tax Division at (614) 752-2496 or mail your extension to:

Ohio Department of Taxation

Public Utility Tax Division - PUGRTEXT

P. O. Box 530

Columbus, OH 43216-0530

Confirmation of Extension - For use by Public Utility Division Only

Your extension request has been approved for ______ Days;

*Due by: ______________

Your extension request has been denied because

Tax Agent/Supervisor Signature

Date

*"Due by" or "receives" means actual receipt of the document by the Department of Taxation on or before that date (not a mailing date).

Application For Extension Request Form - Ohio 2002 Annual Statement Of Gross Receipts