Form 1127 APPLICATION FOR EXTENSION OF TIME FOR PAYMENT OF TAX

(Rev, 5-92)
Department of the Treasu - oe
internal Revenue Service (Please read conditions on back before completing this form)
Taxpayer's Name (include Spouse if this is for a joint return) Social Security Number or
Please Employer Identification Number
Type Present Address
Print ‘Spouse's Social Security Number
i Spouse’
City, Town or Post Office, State, and Zip Code if this is for a Joint Return

District Director of Internal Revenue at

(Enter City and State where IRS Office is located)

I request an extension from ,19 , to ,19 ;
(Enter Due Date of Return)

to pay tax of $__ for the year ended » 19.

This extension is necessary because (If more space is needed, please attach a separate sheet):

I can not borrow to pay the tax because:

To show the need for the extension, I am attaching: (1) a statement of my assets and liabilities at the end of last month (showing
book and market values of assets and whether securities are listed or unlisted); and (2) an itemized list of money I received and spent for
3 months before the date the tax is due.

I propose to secure this liability as follows:

Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules and statements, and
to the best of my knowledge and belief it is true, correct, and complete.

SIGNATURE (BOTH SIGNATURES IF THIS IS FOR A JOINT RETURN) (DATE)

The District Director will let you know whether the extension is approved or denied and will tell you the form of bond, if necessary.
However, the Director cannot consider an application if it is filed after the due date of the return. A list of approved surety companies will
be sent to you upon request.

(The following will be filled in by the IRS.)

This application is  () approved for the following reasons:
OO) denied

Interest += Cate of assessment ____...__ Identifying no.

Penalty

(SIGNATURE) (DATE)

(over) Form 1127 (Rev. 5-92)


CONDITIONS UNDER WHICH EXTENSIONS FOR PAYMENTS MAY BE GRANTED
UNDER SECTION 6161 OF THE INTERNAL REVENUE CODE

The District Director may approve an extension for payment of your tax if you show that it will cause you undue hardship to pay it
on the date it is due. Your application must be filed with the District Director on or before the date payment is due.

If you are asking to pay the amount you owe in installments, rather than to delay making any payments, do not complete this form.
Instead, contact your local IRS office, or call 1-800-829-1040. However, if you owe a deficiency (an amount owed after your return is
examined), you can discuss an installment agreement with the person who examines your return when you agree to the deficiency.

1. Undue hardship.—This means more than inconvenience. You must show that you will have substantial financial loss if you pay your
tax on the date it is due. (This loss could be caused by selling property at a sacrifice price.) You must show that you do not have enough
cash, above necessary working capital, to pay the tax. In determining cash available, include anything you can convert into cash, and use
current market prices. Also, show that you can not borrow to pay the tax, except under terms that will cause you severe loss and
hardship.

2. Limits.—As a general rule, an extension to pay income or gift tax on a return is limited to 6 months from the date payment is due. An
extension may be granted for more than 6 months if you are abroad.

An extension to pay a deficiency (an amount you owe after an examination of your return) in income or gift tax is limited to 18
months from the date payment is due and, in exceptional cases, up to another 12 months.

No extension is granted to pay a deficiency caused by negligence, intentional disregard of rules and regulations, or fraud with intent
to evade tax.

3. Interest.—Interest is charged at the underpayment rate in Code section 6621(a)(2).

4. Security.—Security satisfactory to the District Director is required to get an extension. This assures that the risk to the Government is
no greater at the end of the extension than at the beginning. The kind of security, such as bond, notice of lien, mortgage, pledge, deed of
trust of specific property or general assets, personal surety, or other, will depend on the circumstances in each case. Ordinarily, when you
receive approval of your application, deposit with the District Director any collateral that was agreed upon for security. No collateral is
required if you have no assets.

5. Due date of payment for which extension is granted.—Before the extension runs out, pay the tax for which the extension is granted
(without notice and demand from the District Director).

6. Filing requirements.—If you need an extension to pay tax, submit an application with supporting documents on or before the date the
tax is due. File the application with the District Director (Attn: Chief, Special Procedures function) where you maintain your legal
residence or principal place of business. If, however, the tax will be paid to the Assistant Commissioner (International), file the application
with that office. If you need an extension to pay estate tax, file Form 4768, Application for Extension of Time to File U.S. Estate Tax
Return and/or Pay Estate Tax.

Form 1127 (Rev. 5-92)

U.S. GPO: 1962-312-711 /61562