Municipal Income Tax Extension Request Form - 2004 printable pdf download

Municipal Income Tax Extension Request Form - 2004

2004

EXTENSION REQUEST FORM

2004

MUNICIPAL INCOME TAX

The TRICOTA Member Cities who will accept this extension form are: Alliance, Carrollton, Columbiana,

East Palestine, Garrettsville, Girard, Hubbard, Jefferson, Leetonia, Lisbon, Lordstown, Lowellville, Malvern,

McDonald, Minerva, Newton Falls, New Waterford, Niles, Salem, Sebring, Struthers, Warren, and

Youngstown. The Extension Request Form must be received by the due date of their municipal income tax

return.

The City of Campbell and Canfield will no longer accept this form. They require a copy of the federal

extension by the due date of their municipal income tax return.

FOR MUNICIPALITY OF _____________________________ ACCOUNT NUMBER ________________

SSN __________________________________

EIN ___________________________________

NAME _______________________________________________________________________________

ADDRESS ____________________________________________________________________________

CITY __________________________________ STATE ________ ZIP CODE ____________________

I HEREBY REQUEST AN EXTENSION OF TIME FOR FILING THE MUNICIPAL INCOME

TAX RETURN FOR: ____ CALENDAR YEAR 2004 or ____ FISCAL YEAR ________

Please note: For taxable year 2004 the extended due date for filing the municipal income tax return is the

last day of the month following the month to which the due date of the federal income tax return has been

extended.

CHECK APPROPRIATE LINE AND COMPLETE IF NECESSARY:

_____ Individual 4 month extension to September 30, 2005.

_____ Individual additional extension to November 30, 2005.

_____ Calendar year 3 month Partnership extension to August 31, 2005.

_____ Calendar year 6 month Corporate extension to October 31, 2005.

_____ Fiscal year 6 month Corporate extension to ___________________ _______, __________

I UNDERSTAND THIS IS NOT AN EXTENSION FOR PAYING THE TAX OWED.

________________________________________

_______________________________________

Taxpayer Signature

Preparer Signature if other than Taxpayer

TRICOTA/EXT/04

Municipal Income Tax Extension Request Form - 2004