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

(Rev. March 1999) 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.

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

Form 5500, 5500-C/R or 5500-EZ (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 (if line 1b is checked)

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 for extension to file Form 5330 IS approved to the date shown on line 1, if line 1b is checked. (You

MUST attach an approved copy of this form to each Form 5330 that was granted an extension.)

This application for an extension for Form 5330 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. 3-99)

Filer’s Identifying Number—Check applicable box and enter

number (see instructions).

Cat. No. 12005T

Applicants for extension of Form 5330: 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, plan administrator, 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

if line 1b

is checked

The date entered on line 1 is more than the 6-month maximum time allowed for Form 5330. This application is approved

to (You MUST attach an approved copy

of this form to each Form 5330 that was granted an extension.)

The application for an extension for Form 5330 IS NOT approved, because it was filed after the normal due date of the

return. (A 10-day grace period IS NOT granted.)

File before the

normal due

date of the

Form 5500,

5500-C/R,

5500-EZ, or

5330 (see

instructions)

The application IS automatically approved to the date shown on line 1 (above) if: (1) box 1a is checked, (2) the Form 5558 is

signed and filed on or before the normal due date of Form 5500, 5500-C/R or 5500-EZ for which this extension is requested, and

(3) the date on line 1 is no more than 21⁄2 months after the normal due date.

To Be Completed by the IRS if line 1b is checked Ä

You must attach a copy of this Form 5558 to each Form 5500, 5500-C/R and 5500-EZ filed after the due date for the plans listed below.

Type of plan (check)

Pension Welfare Fringe
Form 5558 (Rev. 3-99) Page 2

Line 3 (complete only if box 1b is

checked)

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time: 33

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.

Lines 1a and 1b

How To File

If your application for an extension of time to

file a Form 5500 series return/report is filed on or

before the return/report’s normal due date on a

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 normal 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 one Form 5500 series

return/report. Attach a list showing the name,

type, 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.

If you are requesting an extension of time to file

Form 5500, 5500-C/R or 5500-EZ only, file Form

5558 before the return/report’s normal due date.

If you are requesting an extension of time to file

Form 5330, file Form 5558 in sufficient time for

the Internal Revenue Service to consider and act

on it before the return’s normal due date. The

normal due date is the date the Form 5500,

5500-C/R, 5500-EZ or 5330 would otherwise be

due, without extension.

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

administrator’s or 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 checked box 1(b)

and 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

(not to exceed 6 months) for filing Form 5330 if

you file a timely application showing that you are

unable to file Form 5330 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 normal 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, plan sponsor, 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 Form 5330 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

General Instructions

If your application for extension of time to file

Form 5330 is approved, you may be granted an

extension of up to 6 months after the normal

due date of Form 5330. Enter the amount of tax

estimated to be due with Form 5330 and attach

your payment to this form.

A Change To Note

Effective for plan years beginning after 1997, all

applications for extension of time to file Form

5500, 5500-C/R and 5500-EZ that are filed on or

before the return/report’s normal due date on a

properly completed and signed Form 5558 will

be automatically approved to the date that is not

more than 21⁄2 months after the return/report’s

normal due date. Approved copies of Form 5558

will not be returned to the filer from the IRS. The

requirement to attach a copy of the approved

extension to the Forms 5500, 5500-C/R and

5500-EZ has been eliminated. Instead, a

photocopy of the extension request that was

filed must be attached. Applications for

extension of time to file Form 5330 will continue

to be returned to the applicant as approved or

not approved.

Specific Instructions

Name and Address

Paperwork Reduction Act Notice

When To File

properly completed and signed Form 5558, you

will automatically be granted one extension of

not more than 21⁄2 months.