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pdfForm
8809-I
Application for Extension of Time
to File FATCA Form 8966
(November 2015)
Department of the Treasury
Internal Revenue Service
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Information about Form 8809-I and its separate instructions is at www.irs.gov/form8809i.
1
Name of filer
2
Number, street, and room or suite no. If a P.O. box, see instructions.
3a City or town
4
OMB No. 1545-2246
3b State, province, or region
5
Filer global intermediary identification number (GIIN)
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6a Filer Point of Contact (POC) name
3c Country (including postal code)
Taxpayer identification number (TIN)
.
6b Filer POC email
7
Name of sponsored entity or intermediary, if applicable
8
Number, street, and room or suite no. If a P.O. box, see instructions.
9a City or town
6c Filer POC phone number
9b State, province, or region
11 TIN
10 GIIN of sponsored entity or intermediary
.
12 Check your method of filing Form 8966
9c Country (including postal code)
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Electronic
Paper
13 Check this box only if you already requested the automatic extension and you now need an additional extension. See instructions
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14 If you checked the box on line 13, state in detail why you need an additional extension of time. You must provide sufficient cause as to why you
were not able to file by the date granted by the first extension request. If you need more space, attach additional sheets. Include the filer name,
TIN, and GIIN on each additional page.
Under penalties of perjury, I declare that I have examined this form, including any accompanying statements, and, to the best of my knowledge and belief, it is true, correct,
and complete.
Signature ▶
Title ▶
For Paperwork Reduction Act Notice, see separate instructions.
Date ▶
Cat. No. 67371G
Form 8809-I (11-2015)
File Type | application/pdf |
File Title | Form 8809-I (November 2015) |
Subject | Fillable |
Author | SE:W:CAR:MP |
File Modified | 2015-11-17 |
File Created | 2015-11-17 |