Form 1138 - Extension Of Time For Payment Of Taxes By A Corporation Expecting A Net Operating Loss Carryback

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1138
Extension of Time for Payment of Taxes by a
Corporation Expecting a Net Operating Loss Carryback
Form
OMB No. 1545-0123
(Rev. September 2016)
(Under Section 6164 of the Internal Revenue Code)
Department of the Treasury
Information about Form 1138 and its instructions is at
Internal Revenue Service
▶
Name
Employer identification number
Number, street, and room or suite no. If a P.O. box, see instructions.
City or town, state, and ZIP code
1
Ending date of the tax year of the expected net operating loss (NOL)
2 Amount of expected NOL
$
3
Reduction of previously determined tax attributable to the expected NOL carryback
(see instructions—attach schedule)
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$
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4
Ending date of the tax year immediately preceding the tax year of the expected NOL
5
Give the reasons, facts, and circumstances that cause the corporation to expect an NOL.
6
Amount for which payment is to be extended:
a Enter the total tax shown on the return, plus any amount assessed as a deficiency, interest, or
penalty. See instructions .
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6a
b Enter amounts from line 6a that were already paid or were required to have been paid, plus refunds,
credits, and abatements. See instructions .
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6b
c Subtract line 6b from line 6a. Don’t enter more than the amount on line 3 above. This is the amount
of tax for which the time for payment is extended
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6c
Sign
Under penalties of perjury, I declare that I have examined this form, including any accompanying schedules and statements, and
to the best of my knowledge and belief it is true, correct, and complete.
Here
Keep a copy of
this form for
Signature of officer
Date
Title
your records.
1138
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 9-2016)
Cat. No. 17250W

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