Form 7004

Form 7004 (Rev. December 2012) Ocostment of tee Nemoo Internal Revenue Senme Application for Automatic Extension of Time To File Certain Business Income Tax, Information, and Other Returns ► File a separate application for each return. ► Information about Form 7004 and its separate instructions is at www.irs.gov/form7OO4. OMB NO. L: IS-1,233 Print or Type Name Number. street. and room or suite no. (If M. box. see instructions.) Identifying number City, town. state, and ZIP code Of a foreign address. enter city. province or state. and country (follow the country's practice for entering postal code)). Note. File request for extension by the due date of the return Mr which the extension is granted. See instructions before cornpledng this form. Automatic 5-Month Extension la triter me rorm coae Tor me return mat mis a plicauon is to (see Detow) I i I Application Is Fon Form 1065 Form Code Application Is Fon Form Code 09 Form 1041 (estate other than a bankruptcy estate) 04 Form 8804 31 Form 1041 (trust) 05 Part II Automatic 6-Month Extension o trner me rorm coae tot' me return mat rats appncauon is rorjsee Delow) I i i Application Is For Form Code Application Is Fon Form Code Form 706-GS(D) 01 Form 1120-ND (section 4951 taxes) 20 Form 706-GS(T) 02 Form 1120-PC 21 Form 1041 (bankruptcy estate only) 03 Form 1120-POL 22 Form 1041-N 06 Form 1120-REIT 23 Form 1041-OFT 07 Form 1120-RIC 24 Form 1042 08 Form 1120S 25 Form 1065-B 10 Form 1120-SF 26 Form 1066 11 Form 3520-A 27 Form 1120 12 Form 8612 28 Form 1120-C 34 Form 8613 29 Form 1120-F 15 Form 8725 30 Form 1120-FSC 16 Form 8831 32 Form 1120-H 17 Form 8876 33 Form 1120-L 18 Form 8924 35 Form 1120-ND 19 Form 8928 36 2 If the organization is a foreign corporation that does not have an office or place of business in the United S ates, 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 statement, listing the name, address, and Employer Identification Number (EIN) for each member covered by this application. Part III 0 0 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 b The application is for calendar year 20.... , or tax year beginning Short tax year. If this tax year is less than 12 months, check the reason: , 20 , and ending ,20 K Initial return K Final return K Change in accounting period K Consolidated return to be filed K Other (see instructions-attach explanation) 6 Tentative total tax 6 7 Total payments and credits (see instructions) 7 8 Balance due. Subtract line 7 from line 6 (see instructions) 8 For Privacy Act and Paperwork Reduction Act Notice, see separate Instructions. Farr, 7004 (Rev. 12-2012) EFTA01222764