OMB No, 1545-0212

rom 5598 Application for Extension of Time Expires 1-31.93

Rev. February 1990) , .
(Rev. February 1990) To File Certain Employee Plan Returns
Department of the Treasury

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 DUPLICATE instructions).

by the due date [Employer identification number (EIN). Filers checking

for filing the ‘Address (number and street) any box in 1a through 1d must enter an EIN. All other

return, filers see specific instructions.

(Gee general > OR

instructi ~ ~

2and3) City or town, state, and ZIP code (Gl Social security number. Form 5330 filers see instructions.

>

1 | request an extension of time until (see specific instructions) > _ (check appropriate block(s)):

a C1 To file Form 5500, Annual Return/Report of Employee Benefit Plan (with related schedules).

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

c CO To file Form 5500EZ, Return of One-Participant Pension Benefit Plan (with related schedule).

dO To file Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, for tax year beginning P ______.__....-2------
and ending >
2 Ifyou checked d above, are you electing to be taxed under ERISA section 2003(c(1(B)?. . . . . . .  . OYes CNo
3a(i) If you have never filed a Form 5500, 5500-C/R, or 5500EZ for your plan, check this box » [1

(ii) If you checked a(i), enter the plan administrator's: Name and address

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
5a Has an extension of time to file the Form 5330 been previously granted forthistaxyear? . . . . . . . . . OF Yes DNo

ov

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. 5. we

Caution: Interest 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/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.

1 The application IS approved to > . (You MUST attach a copy of this form

to each return you file for which an extension is gt .
CO. 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.
0 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.
This application cannot be considered since the maximum extension of time allowed is 24 months (6 months for Form 5330).

oo00

(Date) (Director)

Form 5558 (Rev. 2-90)


Form 5558 (Rev. 2-90)

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.

The time needed to complete this form
will vary depending on individual
circumstances. The estimated time is:

36 minutes.

If you have comments concerning the
accuracy of this time estimate or
suggestions for making this form more
simple, we would be happy to hear from
you. You can write to the Internal Revenue
Service, Washington, DC 20224, Attention:
IRS Reports Clearance Officer,T:FP or the
Office of Management and Budget,
Paperwork Reduction Project (1545-0212),
Washington, DC 20503.

1. Purpose.—Form 5558 may be used to
apply for an extension of time to file Form
5500, 5500-C/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).

Caution: If we give you more time to file
and later find that the statements made on
this form are false or misleading, the
extension is null and void. You will owe the
late filing penalty associated with the form
for which you filed this extension.

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/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/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. Form
5500, 5500-C/R and 5500EZ filers see
specific instructions for line 1.

Specific Instructions

Name and Address.—f you are a single
employer and are requesting an extension
of time to file the annual return/report
Form 5500, 5500-C/R, or 5500EZ 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/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 returns for which you are requesting an
extension.

If your application for an extension to file
Form 5500, 5500-C/R, or 5500EZ is
approved, you will be granted only one
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/R, and
5500€EZ, then the extension also applies to
the Forms 5500, 5500-C/R, and 5500EZ.

Attach a copy of the IRS extension to file
the income tax return to each Form 5500,
5500-C/R, and 5500€Z that is filed after
the normal due date. However, if you want
an extension beyond the date of the
corporate income tax return extension, you
must file a Form 5558 before the normal
due date (without extension) of the Forms
5500, 5500-C/R and 5500EZ.

lf 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 amount 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.