Form 5558 Application for Extension of Time OMB No. 1545-0212

(Rev. November 1997) To File Certain Employee Plan Returns

Department of the Treasury

Internal Revenue Service File With IRS Only © For Paperwork Reduction Act Notice, see instructions on back.

File before

the due date

for filing the

return (see

instructions)

1 I request an extension of time until / / to file (check appropriate box(es)).

Form 5500 series (no more than 21 a ⁄2 months).

b Form 5330 (no more than 6 months). Payment amount attached is $ (see instructions)

2

Plan year ending

Complete the following for the plan(s) covered by this application (see How To File):

Plan

number Month Day Year Plan name/filer

3 State in detail why you need the extension

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 ©

This application IS approved to the date shown on line 1. (You MUST attach an approved copy of this form to each

return that was granted an extension.)

This application IS NOT approved, because

The application was not signed.

No reason was given on this application or the reason was not acceptable.

Other ©

(Date) (Director)

© OR

Employer identification number (EIN). Filers checking box

1a must enter an EIN. All other filers, see specific

instructions.

By:

Form 5558 (Rev. 11-97)

Filer’s Identifying Number—Check applicable box and enter

number (see instructions).

Cat. No. 12005T

Complete if you want this Form 5558 returned to an address other than the address shown above.

Name

Please

Print

or

Type

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

City or town, state, and ZIP code

Name of filer or plan sponsor (see instructions)

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

City or town, state, and ZIP code Social security number (see Specific Instructions)

©

month day year

No payment was attached for the tax due on Form 5330.

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.)

Notice to

Applicant

To Be

Completed

by the IRS

The date entered on line 1 is incorrect. The maximum time allowed is 21⁄2 months for Form 5500 series (6 months for

Form 5330). This application is approved to (You MUST attach an approved copy

of this form to each return that was granted an extension.)

The application IS NOT approved, because it was filed after the due date of the return. (A 10-day grace period is NOT

granted.)
Form 5558 (Rev. 11-97) Page 2

Line 3

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time:

26 minutes.

If you have comments concerning the

accuracy of this time estimate or suggestions

for making this form simpler, we would be

happy to hear from you. You can write to the

Tax Forms Committee, Western Area

Distribution Center, Rancho Cordova, CA

95743-0001. DO NOT send the tax form to

this address. Instead, see Where To File

above.

Filer’s Identifying Number

Purpose of Form

Note: An extension of time to file a Form 5500

series return/report does not operate as an

extension of time to file the PBGC Form 1.

Employers who do not have an EIN may

apply for one by attaching a completed Form

SS-4 to this form.

Line 1

How To File

If your application for an extension of time

to file a Form 5500 series return/report is

approved, you will be granted one extension

of not more than 21⁄2 months.

An extension of time to file does not extend

the time to pay the tax due. Any tax due

must be paid with this application.

Exception: Form 5500 series return/report

filers are automatically granted extensions of

time to file until the extended due date of the

Federal income tax return of the employer

(and are not required to file Form 5558) if all

the following conditions are met: (1) the plan

year and the employer’s tax year are the

same; (2) the employer has been granted an

extension of time to file its Federal income tax

return to a date later than the normal due

date for filing the Form 5500 series

return/report; and (3) a photocopy of the IRS

extension of time to file the Federal income

tax return is attached to the Form 5500 series

return/report. An extension granted under this

exception CANNOT be extended further by

filing a Form 5558 after the original due date

of the Form 5500 series annual return/report. Signature

We ask for the information on this form to

carry out the Internal Revenue laws of the

United States. We need it to determine if you

are entitled to an extension of time to file

your employee plan returns. If you want an

extension, you are required to give us the

information.

Use Form 5558 to apply for a one-time

extension of time to file Form 5500 series

return/reports (Forms 5500, 5500-C/R, and

5500-EZ), or Form 5330. The following

exception does NOT apply to Form 5330.

In general, a separate Form 5558 is used for

each return for which you are requesting an

extension. However, if you are a single

employer and all your plan years end on the

same date, file only one Form 5558 to

request an extension of time to file more than

File Form 5558 in sufficient time for the

Internal Revenue Service to consider and act

on it before the return’s regular due date.

Enter your name and address in the heading

if you are a single employer requesting an

extension of time to file the Form 5500 series

annual return/report. If you are filing for other

than a single employer, enter the plan

sponsor’s name and address on the

application. The plan sponsor listed on this

application should be the same as the plan

sponsor listed on the annual return/report

filed for the plan.

Include the suite, room, or other unit

number after the street address. If the Post

Office does not deliver mail to the street

address and you have a P.O. box, show the

box number instead of the street address. If

you want this form returned to a different

name and/or address, also complete the

name/address section at the bottom of the

form.

Enter the nine-digit employer identification

number (EIN) assigned to the employer for all

applications filed for Form 5500 series

return/report. Also enter the employer’s EIN

for applications filed for Form 5330, unless

you made excess contributions to a Code

section 403(b)(7)(A) custodial account or you

are a disqualified person other than an

employer. If you made excess contributions

as described above or are a disqualified

person other than an employer, enter your

social security number.

Check the Form 5500 series and/or Form

5330 box(es) to indicate the return(s) for

which you are requesting an extension.

The IRS will grant a reasonable extension of

time for filing a return if you file a timely

application showing that you are unable to file

the return because of circumstances beyond

your control. Clearly describe these

circumstances. Generally, an application will

be considered on the basis of your own

efforts to fulfill this filing responsibility, rather

than the convenience of anyone providing

help in preparing the return. However,

consideration will be given to any

circumstances that prevent your practitioner,

for reasons beyond his or her control, from

filing the return by the due date, and to

circumstances in which you are unable to get

needed professional help in spite of timely

efforts to do so.

The form must be signed. The person who

signs this form may be an employer or plan

administrator filing a Form 5500 series

return/report or 5330, a disqualified person

filing Form 5330, an attorney or certified

public accountant qualified to practice before

the IRS, a person enrolled to practice before

the IRS, or a person holding a power of

attorney.

Caution: If we grant you an extension of time

to file and later find that the statements made

on this form are false or misleading, the

extension will be null and void. A late filing

penalty associated with the form for which

you filed this extension will be charged.

Interest is charged on taxes not paid by the

due date even if an extension of time to file is

granted.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB control

number. Books or records relating to a form

or its instructions must be retained as long as

their contents may become material in the

administration of any Internal Revenue law.

Generally, tax returns and return information

are confidential, as required by Code section

6103.

Where To File

File Form 5558 with the Internal Revenue

Service Center indicated below. No street

address is needed.

If the principal office of

the plan sponsor or the

plan administrator is

located in

Use the following

Internal Revenue

Service Center

address

Ä Ä

Connecticut, Delaware,

District of Columbia,

Foreign Address, Maine,

Maryland, Massachusetts,

New Hampshire, New

Jersey, New York,

Pennsylvania, Puerto Rico,

Rhode Island, Vermont,

Virginia

Holtsville, NY 00501

Alabama, Alaska, Arkansas,

California, Florida, Georgia,

Hawaii, Idaho, Louisiana,

Mississippi, Nevada, North

Carolina, Oregon, South

Carolina, Tennessee,

Washington

Atlanta, GA 39901

Arizona, Colorado, Illinois,

Indiana, Iowa, Kansas,

Kentucky, Michigan,

Minnesota, Missouri,

Montana, Nebraska, New

Mexico, North Dakota,

Ohio, Oklahoma, South

Dakota, Texas, Utah, West

Virginia, Wisconsin,

Wyoming

Memphis, TN 37501

All Form 5500-EZ filers Memphis, TN 37501

Paperwork Reduction Act Notice

General Instructions

When To File

Specific Instructions

Name and Address

If your application for extension of time to

file Form 5330 is approved, you may be

granted an extension of up to 6 months.

Enter the amount of tax estimated to be due

with Form 5330 and attach your payment to

this form.

one Form 5500 series return/report. Attach a

list showing the name and plan number of all

the plans for which you are requesting an

extension and show the month, day, and year

the plan year ends.