Form
4868
Application for Automatic Extension of Time To File U.S. Individual Income Tax Return
This is not an extension of time to pay your tax. See separate instructions.
Last name
OMB No. 1545-0188
Department of the Treasury Internal Revenue Service
Your first name and initial
Your social security number
Please Type or Print
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Home address (number, street, and apt. no. or rural route). If you have a P.O. box, see the instructions.
City, town or post office, state, and ZIP code
I request an automatic 4-month extension of time to August 15, 1994, to file Form 1040EZ, Form 1040A, or Form 1040 for the calendar year 1993 or to , 19 , for the fiscal tax year ending , 19 .
Part I
Individual Income Tax—You must complete this part.
1
Total tax liability for 1993. This is the amount you expect to enter on Form 1040EZ, line 8; Form 1040A, line 27; or Form 1040, line 53. If you expect this amount to be zero, enter -0Caution: You MUST enter an amount on line 1 or your extension will be denied. You can estimate this amount, but be as exact as you can with the infor mation you have. If we later find that your estimate was not reasonable, the extension will be null and void.
1
2
Total payments for 1993. This is the amount you expect to enter on Form 1040EZ, line 7; Form 1040A, line 28d; or Form 1040, line 60 BALANCE DUE. Subtract line 2 from line 1. If line 2 is more than line 1, enter -0-. For details on how to pay, including what to write on your payment, see the instructions
2
3
3
Part II
Gift or Generation-Skipping Transfer (GST) Tax—Complete this part if you expect to owe either tax.
Caution: Do not include income tax on lines 5a and 5b. See the instructions. 4 If you or your spouse plan to file a gift tax return (Form 709 or 709-A) for 1993, generally due by April 15, 1994, see the instructions and check here Yourself Spouse 5a 5b
5a Enter the amount of gift or GST tax you are paying with this form b Enter the amount of gift or GST tax your spouse is paying with this form
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete; and, if prepared by someone other than the taxpayer, that I am authorized to prepare this form.
Your signature
Date
Spouse’s signature, if filing jointly
Date
Preparer’s signature (other than taxpayer)
Date
If you want correspondence regarding this extension to be sent to you at an address other than that shown above or to an agent acting for you, please enter the name of the agent and/or the address where it should be sent.
Name
Please Type or Print
Number and street (include suite, room, or apt. no.) or P.O. box number if mail is not delivered to street address
City, town or post office, state, and ZIP code
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 13141W
Form
4868
(1993)