rom 9598 Application for Extension of Time owes331 90

(Rev. March 1987) a |
Department of the Treasury To File Certain Employee Plan Returns

File With IRS Only

Internal Revenue Service > For Paperwork Reduction Act Notice, see Instructions on back.
Name of taxpayer or plan sponsor (see instructions) Check applicable box and enter number (see specific
File in DUPLI instructions).
Gare by the [1 Employer identification number (EIN). Filers checking
fing ane ‘Address (number and street) any box in 1a through 1d must enter an EIN. All other

filers see specific instructions

return

(See general
ipstructions | City or town, state, and ZIP code O Social security number. Form 5330 filers see instructions.
>

1 | request an extension of time until (see specific instructions) P__..........22.-.-- (check appropriate block(s)):
a (O Tofile Form 5500, Annual! Return/Report of Employee Benefit Plan (with related schedules).
b (CO To file Form 5500-C, Return/Report of Employee Benefit Plan (with related schedules).
c QO Tofile Form 5500-R, Registration Statement of Employee Benefit Plan (with related schedules).
d (J To file Form 5500EZ, Return of One-Participant Pension Benefit Plan (with related schedule).
e (CO Tofile Form 5330, Return of Initial Excise Taxes Related to Employee Benefit Plans, for tax year beginning B® ___.........-....

and ending > wees _
2. If you checked e above, are you electing to be taxed under ERISA section 2003(c)(1)(B)? «wt. ..... OYes ONo
3. Ifyou have never filed a Form 5500, 5500-C, 5500-R, or 5500EZ for your plan, check this box > oO
4 Complete the following for the plan covered by this application (see general instruction 2): Plan Plan year ending
Plan name number Month Day | Year
5 a  Hasanextension of time to file the designated return(s) been previously granted for this tax year? O Yes ONo

b_ If ‘‘Yes,"’ show the date(s) to which the extension was granted

6 Attach a detailed statement of why you need the extension (see specific instructions).

7 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... . 0... ee ee

Caution: /nterest on late payment of tax accrues at the rate established under section 6621(a)(2) 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 instructions.)

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 | 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-R, 5500EZ, 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.

0 The application IS approved to >
to each return you file for which an extension is granted.)

C1 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.

(1 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.)

(You MUST attach a copy of this form

01 The application cannot be considered, since you filed it after the due date of the return.
OF Other monn ee eee eee eee
By:
ate) (irector)

Form 5558 (Rev. 3-87)


Form 5558 (Rev. 3-87)

Page 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 collecting 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 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
such an extension, you are required to give
us this information.

1, Purpose.—Form 5558 may be used to
apply for an extension of time to file Form
5500, 5500-C, 5500-R, 5500EZ, or 5330.
No extension will be granted if you are
electing to be taxed under section
2003(c)(1)(B) of the Employee 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-R, or
5500EZ. Attach a list showing the plan
names and numbers of all of the plans for
which you are requesting 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
where you will file your Form 5500, 5500-C,
5500-R, 5500EZ, or 5330. See the
instructions for the form you intend to file
for a list of locations.

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

Specific Instructions

Name and Address.—If you are a single
employer and are requesting an extension
to file the annual return/report Forms.
5500, 5500-C, 5500-R, or 5SO0EZ you
must enter your name and address in the
heading. 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.

Employer Identification Number or
Social Security Number.—Enter the nine-
digit employer identification number (EIN)
assigned to the employer for all applications
filed for Forms 5500, 5500-C, 5500-R, and
5500EZ. 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 did make excess
contributions as described above, or are a
disqualified person other than an employer,
enter your social security number.

Employers who do not have an EIN
should apply for one by attaching a
completed Form SS-4 to this form when it is
filed.

Line 1.—Check the box or boxes to indicate
the return for which you are requesting an
extension.

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

Note: /f you are filing for a single employer
plan or for a plan of a controlled group of
corporations that file a consolidated income
tax return and the plan year and the tax year
coincide, and you have been granted an
extension of time to file your income tax
return to a date that is beyond the due date
of the Forms 5500, 5500-C, 5500-R, and
5500€Z, then the extension also applies to
the Forms 5500, 5500-C, 5500-R, and
5500EZ.

U.S. Government Printing Office: 1987—181-447/40128

Attach a copy of the approved IRS
extension to file the income tax return to
each Form 5500, 5500-C, 5500-R, and
5500EZ 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 6 months.

Line 6.—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 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.

Applications that give incomplete
reasons, such as “‘illness’’ or ‘‘practitioner
too busy,"’ without adequate explanations
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 request and the
10-day grace period.

Line 7.—If you are applying for an
extension of time to file Form 5330,
estimate the amount of tax due with Form
5330 and enter the total on line 7.

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

The law imposes a penalty for late
payment of tax. The maximum penalty is
25% of the unpaid amount

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