Form 7004 Application for Automatic Extension of Time to File Cert

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 7004, PAGE 1 of 2 (PAGE 2 IS BLANK)
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 432mm (17") x 279mm (11") FOLD TO: 216mm (81⁄ 2 ") x 279mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Date

Form

7004

Action

Date

O.K. to print
Revised proofs
requested

Application for Automatic Extension of Time To File Certain
Business Income Tax, Information, and Other Returns

(Rev. December 2008)

Name

Type or
Print

OMB No. 1545-0233

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Department of the Treasury
Internal Revenue Service

Signature

File a separate application for each return.
© See separate instructions.

Identifying number

Number, street, and room or suite no. (If P.O. box, see instructions.)

File by the due
date for the
return for which
an extension is
requested. See
instructions.

City, town, state, and ZIP code (If a foreign address, enter city, province or state, and country (follow the country’s practice for entering
postal code)).

Note. See instructions before completing this form.
Part I
Automatic 5-Month Extension Complete if Filing Form 1065, 1041, or 8804
1a Enter the form code for the return that this application is for (see below)
Application
Form
Application
Is For:
Code
Is For:
Form 1041 (estate)
Form 1065
09
Form 8804
Form 1041 (trust)
31

Part II

Form
Code
04
05

Automatic 6-Month Extension Complete if Filing Other Forms

b Enter the form code for the return that this application is for (see below)
Application
Form
Application
Form
Is For:
Code
Is For:
Code
Form 706-GS(D)
Form 1120-PC
01
21
Form 706-GS(T)
Form 1120-POL
02
22
Form 1120-REIT
Form 1041-N
23
06
Form 1120-RIC
Form 1041-QFT
07
24
Form 1042
Form 1120S
08
25
Form 1065-B
Form 1120-SF
10
26
Form 3520-A
Form 1066
27
11
Form 8612
28
Form 1120
12
Form 8613
Form 1120-C
29
34
Form 8725
30
Form 1120-F
15
Form 8831
16
32
Form 1120-FSC
Form 8876
17
33
Form 1120-H
Form 1120-L
Form 8924
18
35
Form 1120-ND
Form 8928
19
36
Form 1120-ND (section 4951 taxes)
20
2 If the organization is a foreign corporation that does not have an office or place of business in the United States,
©
check here
3 If the organization is a corporation and is the common parent of a group that intends to file a consolidated return,
©
check here
If checked, attach a schedule, listing the name, address, and Employer Identification Number (EIN) for each member
covered by this application.

Part III

All Filers Must Complete This Part

4 If the organization is a corporation or partnership that qualifies under Regulations section 1.6081-5, check here
5a The application is for calendar year 20
, or tax year beginning
, 20
, and ending
b Short tax year. If this tax year is less than 12 months, check the reason:
Initial return
Final return
Change in accounting period
Tentative total tax

6

7

Total payments and credits (see instructions)

7

8

Balance due. Subtract line 7 from line 6. Generally, you must deposit this amount using the
Electronic Federal Tax Payment System (EFTPS), a Federal Tax Deposit (FTD) Coupon, or
Electronic Funds Withdrawal (EFW) (see instructions for exceptions)
Cat. No. 13804A

, 20

Consolidated return to be filed

6

For Paperwork Reduction Act Notice, see Instructions.

©

8
Form

7004

(Rev. 12-2008)