Form 5558 - Application For Extension Of Time To File Certain Employee Plan Returns
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1
25558
Application for Extension of Time
Form
OMB No. 1545-0212
To File Certain Employee Plan Returns
(Rev. June 2001)
File With IRS Only
Department of the Treasury
For Paperwork Reduction Act Notice, see instructions on back.
Internal Revenue Service
Filer’s Identifying Number—Check applicable box and enter
Name of filer, plan administrator, or plan sponsor (see instructions)
File before the
number (see instructions).
normal due
Employer identification number (EIN). Filers checking box
date of the
Number, street, and room or suite no. (If a P.O. box, see instructions.)
1a must enter an EIN. All other filers, see Specific
Form 5500,
Instructions.
OR
5500-EZ, or
5330 (see
City or town, state, and ZIP code
Social security number (see Specific Instructions)
instructions)
1
I request an extension of time until
/
/
to file (check appropriate box(es)).
month
day
year
a
Form 5500 or 5500-EZ (no more than 2
1
⁄
months).
2
The application is automatically approved to the date shown on line 1 (above) if: (1) box 1a is checked, (2) the Form 5558 is
signed and filed on or before the normal due date of Form 5500 or 5500-EZ for which this extension is requested, and (3) the date
on line 1 is no more than 2
⁄
months after the normal due date.
1
2
You must attach a copy of this Form 5558 to each Form 5500 and 5500-EZ filed after the due date for the plans listed below.
Form 5330 (no more than 6 months). Payment amount attached is $
b
(see instructions)
2
Complete the following for the plan(s) covered by this application (see How To File):
Type of plan (check)
Plan year ending
Plan
Plan name/filer
number
Pension Welfare Fringe
Month
Day
Year
3
State in detail why you need the extension (if line 1b is checked)
Under penalties of perjury, I declare that to the best of my knowledge and belief the statements made on this form are true, correct, and complete, and that I am
authorized to prepare this application.
Signature
Date
Notice to
To Be Completed by the IRS if line 1b is checked
Applicant
This application for extension to file Form 5330 IS approved to the date shown on line 1, if line 1b is checked. (You
must attach an approved copy of this form to each Form 5330 that was granted an extension.)
The date entered on line 1 is more than the 6-month maximum time allowed for Form 5330. This application is approved
to
(You must attach an approved copy
To Be
of this form to each Form 5330 that was granted an extension.)
Completed
by the IRS
The application for an extension for Form 5330 is not approved, because it was filed after the normal due date of the
if Line 1b
return. (A 10-day grace period is not granted.)
Is
This application for an extension for Form 5330 is not approved, because
Checked
The application was not signed.
No reason was given on this application or the reason was not acceptable.
No payment was attached for the tax due on Form 5330.
Other
A 10-day grace period is granted from the date shown below or the due date of the return, whichever is later.
(You must attach a copy of this form to each return you file that is granted a grace period.)
By:
(Date)
(Director)
Applicants for extension of Form 5330: Complete if you want this Form 5558 returned to an address other than the address shown above.
Name
Please
Number, street, and room or suite no. (If a P.O. box, see instructions.)
Print
or
Type
City or town, state, and ZIP code
5558
Cat. No. 12005T
Form
(Rev. 6-2001)
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