rom 5558 Application for Extension of Time pores ats

(Rev. October 1982)

Department ofthe Treasury to File Certain Employee Plan Returns File With IRS Only
Internal Revenue Service > For Paperwork Reduction Act Notice, see Instructions on back
File in DUPLI- | Name of taxpayer or plan sponsor (see instructions) Check applicable box and enter number (see
CATE by the specific instructions)
due date for
filing the Address (Number and street) im Employer identification number
return.
(See general >. ... OR
instructions City or town, State, and ZIP code o Social security number
2 and 3.) >
1 | request an extension of time until (see specific instruction 1) > __ (check appropriate block(s)):

(a) [J To file Form 5500, Annual Return/Report of Employee Benefit Plan (with related schedules).

(b) [7] To file Form 5500-C, Return/Report of Employee Benefit Plan (with related schedules).

(c) [J To file Form 5500-K, Return/Report of Employee Pension Benefit Plan (with related schedules).

(d) [J To file Form 5500-G, Annual Return/Report of Employee Benefit Plan.

(e) [J To file Form 5500-R, Registration Statement of Employee Benefit Plan (with related schedules).

(f) [J To file Form 5330, Return of Initial Excise Taxes Related to Pension and Profit-sharing Plans for tax year beginning

_..and ending P_ —
(g) If you checked (f) above, are you electing to be taxed under ERISA section 2003(c)(1)(B)?.. . . . . . - [J Yes [J No
2 Complete the following for the plan covered by this application (see general instruction 2): Plan Plan year ending
Plan name number Month | Day Year
3 (a) Has an extension of time to file the designated return(s) been previously granted for this tax year?. . . . [] Yes [] No
(b) If “Yes,’’ show the date(s) to which the extension was granted. . . . . . 1

4 Attach a detailed statement of why you need the extension (see specific instruction 4).
5 If the extension is for Form 5330, enter the amount of tax estimated to be due on Form 5330. Pay this amount with

this application... >

Caution: Interest on late payment of tax accrues at the rate established under section 6621 of the Internal Revenue Code from the
regular due date of the return until paid. (For the penalty for late payment of tax, see specific instruction 5.)

Under penalties of perjury, | 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 >

Note: The person who signs this form may be an employer or plan administrator filing Form 5500, 5500-C, 5500-K, 5500-G, 5500—
R 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.

Notice to Applicant—THE INTERNAL REVENUE SERVICE WILL INDICATE BELOW WHETHER THE
EXTENSION IS GRANTED OR DENIED AND WILL RETURN THE ORIGINAL OF THE APPLICATION

1 The application IS approved to > ___

to each return you file for which an extension is granted.)

(J The application IS NOT approved. (You MUST attach a copy of this form to each return you file for which a grace period is granted.)
However, in view of your reasons stated in the application, a 10-day grace period is granted from the date shown below or due
date of the return, whichever is later. This 10-day grace period constitutes a valid extension of time for purposes of elections
otherwise required to be made on timely filed returns.

( The application IS NOT approved.

After consideration of the reasons stated in your application, we have determined the extension is not warranted. (The 10-day
grace period is not granted.)

( The application cannot be considered, since you filed it after the due date of the return.
(J Other p>

_..(You MUST attach a copy of this form

By:

ate) @irectory

363-479-2


If you want the original of this application returned to an address other than that shown on page 1, please fill

in the address below.

Name
Please
Print Address (Number and street)
or
Type City or town, State, and ZIP code

General Instructions

Paperwork Reduction Act Notice.—
The Paperwork Reduction Act of 1980
says we must tell you why we are collect-
ing this information, how we will use it
and whether you have to give it to us. We
ask for it to carry out the Internal Reve-
nue 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 such an exten-
sion you are required to give us this in-
formation.

1. Purpose.—Form 5558 may be used
to apply for an extension of time to file
Form 5500, 5500-C, 5500-K, 5500-G,
5500-R, or 5330. No extension will be
granted if you are electing to be taxed
under section 2003(c)(1)(B) of the Em-
ployee Retirement Income Security Act
of 1974 (ERISA).

2. How and Where to File.—In general,
you must file a separate Form 5558 for
each return for which you are requesting
an extension. However, if you are a single
employer and all of your plan years end
on the same date, you may file one Form
5558 to request an extension of time to
file more than one Form 5500, 5500-C,
5500-K, 5500-R or 5500-G. Attach a
list showing the plan names and numbers
of all of the plans for which you are re-
questing an extension and show the
month, day, and year the plan year ends.

Complete this form in duplicate and
file it with the Internal Revenue Service
Center shown in the list below.

If the principal place of
business, office or agen-
ey (or legal residence,
if you have no principal
place of business or of-
fice or agency in the
United States), is lo-
cated in

Vv

New Jersey, New York
Gity and counties of
Nassau, Rocklan

Sutfoik’ and Westchester

New York (all other
counties), Connecticut,
Maine, Massachusetts,
New Hampshire,
Rhode Island, Vermont

Alabama, Florida,
Georgia, Mississippi,
South Carolina
Michigan, Ohio

Arkansas, Kansas,
Louisiana, New Mexico,
Oklahoma, Texas

Page 2

Use the following
Internal Revenue
Service Center

Holtsville, NY 00501

Andover, MA 05501

Atlanta, GA 31101

Cincinnati, OH 45999

Austin, TX 73301

Alaska, Arizona, Colo-
rado, Idaho, Minnesota,
Montana, Nebraska,
Nevada, North Dakota,
Oregon, South Dakota,
Utah, Washington,
Wyoming

illinois, towa,
Missouri, Wisconsin

California, Hawaii

Ogden, UT 84201

64999
93888

Kansas City, MO

Fresno, CA

Indiana, Kentucky,

North C: 37501

Memphis, TN
West Virginia
Delaware, District of
Columbia, Maryland,
Pennsylvania

If you have no legal residence, principal place
of business or principal office or agency in any
Internal Revenue district, file your return with
the Internal Revenue Service Center, Philadelphia,
PA 19255,

3. When to File.—You should file this
application in sufficient time for the In-
ternal Revenue Service to consider and
act on it before the return’s regular due

date.

Specific Instructions

Name and address.—lf you are a sin-
gle employer and are requesting an ex-
tension to file the annual return/report
Forms 5500, 5500-C, 5500-K, 5500-R,
and 5500-G, you must enter your name
and address in the heading. If you are fil-
ing 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 re-
turn/report filed for the plan.

Employer identification number or so-
cial security number.—If you are filing
this application for an extension of time
to file Form 5330 and you made excess
contributions to either a Code section
403(b)(7)(A) custodial account or a
Keogh (H.R. 10) plan or you are a dis-
qualified person other than an employer,
enter your social security number. In
all other cases, enter the employer
identification number of the person listed
in the name and address block.

Line 1.—Check the box or boxes to in-
dicate the return for which you are re-
questing an extension.

If your application for an extension to
file Form 5500, 5500-C, 5500-K,
5500-R, or 5500-G is approved, you will
be granted an extension of not more than
2¥% months.

If you are filing for a single employer
plan or for a plan of a controlled group of
corporations that file a consolidated in-
come tax return when the plan year and
the tax year coincide, and you have been

Philadelphia, PA 19255

‘3x U.S, GOVERNMENT PRINTING OFFICE : 19%—O-363-479

granted an extension of time to file your
income tax return beyond the due date of
the Forms 5500, 5500-C, 5500-R, and
5500-K, the extension also applies to the
Forms 5500, 5500-C, 5500-R, and
5500-K.

Attach a copy of the approved IRS ex-
tension to file the income tax return to
each Form 5500, 5500-C, 5500-R, or
5500-K that is filed after the normal due
date.

If your application for extension of time
to file Form 5330 is approved, you may
be granted an extension of up to six
months.

Line 4.—Attach a detailed statement
explaining why you need an extension.
The Internal Revenue Service 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. Generally, an application
will be considered on the basis of your
own efforts to fulfill this filing responsi-
bility, rather than the convenience of any-
one providing help in preparing the re-
turn. 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 pro-
fessional help in spite of timely efforts
to do so.

Applications that give incomplete rea-
sons, such as “‘illness’’ or “practitioner
too busy,’ without adequate explana-
tions, will not be approved. If it is clear
that a request for extension is frivolous,
solely to gain time, the Internal Revenue
Service will deny both the extension re-
quest and the 10-day grace period.

Line 5.—If you are applying for an ex-
tension of time to file Form 5330, esti-
mate the amount of tax due with Form
5330 and enter the total on line 5.

The extension of time to file does not
extend the time to pay the tax due. There-
fore, you must pay the amount of tax due
with this application.

The law imposes a penalty for late pay-
ment of tax. The penalty is 14 of 1% of
the unpaid amount for each month or part
of a month it remains unpaid. The maxi-
mum penalty is 25% of the unpaid
amount.

Interest is also charged at the rate pro-
vided by law from the due date of the
return until the date the tax is paid.

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