Form M-4768 - Application For Extension Of Time To File Massachusetts Estate Tax Return
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1
2Rev. 10/99
Form M-4768
Massachusetts
Application for Extension of Time to File
Department of
Massachusetts Estate Tax Return
Revenue
File in duplicate with payment.
Name of decedent
¨
Mail to:
Probate court
Date of death
¨
Name of
¨
applicant
Docket number
Decedent’s Social Security number
¨
Street address
Residence (domicile) at time of death
City/Town,
State, Zip code
Part 1. Extension of Time to File
Application is hereby made to the Commissioner of Revenue for the following extension of time to file the return of the estate named above.
Reason for application for extension:
Mass. estate tax return due date
Extension date requested
¨
Part 2. Payment to Accompany Extension Request
¨ $
1. Estimated amount of Massachusetts estate tax due . . . . . . .
2. Less: Advance and/or estimated payments made (if any) . . . . .
$
3. Prior extension payments (attach copy of Form M-4768
and/or Form M-4768A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Payment in full of the amount in line 4 must be made within nine
months after the date of death of the decedent. If the total amount
4. Balance due with this application. Subtract the total of
paid is less than 80% of the tax finally determined to be due, the
line 2 and line 3 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
extension is void and a penalty for late filing will be assessed.
Part 3. Certification
Name of executor, administrator, or person in possession of decedent’s property
Name of attorney for estate
Street address
Street address
City/Town
State
Zip
City/Town
State
Zip
I declare under the penalties of perjury that this application has been examined by me and to the best of my knowledge and belief it is true
and correct.
Signature
Title
Date
Signature
Title
Date
Part 4. Notice to Applicant.
To be completed by Estate Tax Bureau.
The application for extension of time to file is:
Approved
Not approved
Other
Commissioner of Revenue
Date
By
Make check payable to the Commonwealth of Massachusetts. Send to: Massachusetts Department of Revenue, Estate Tax Bureau, PO Box 7023,
Boston, MA 02204. Attach a copy of this application to the Estate Tax Return when filed.
Form code: 652
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