8809

Department of the Treasury

Internal Revenue Service © Send to Martinsburg, WV. See Where To File on page 2.

(Enter only 1

tax year.)

3 Person IRS can contact about this request Telephone number

Will you provide, or have you provided, a copy of the information return or the required statement to the

recipient on time? (See instructions.)

Under penalties of perjury, I declare that I have examined this form, including any accompanying statements, and, to the best of

my knowledge and belief, it is true, correct, and complete.

2

Request for Extension of Time To

File Information Returns Form

OMB No. 1545-1081

Expires 8-31-94 (Rev. September 1991) (For Forms W-2, W-2G, 1098, 1099, and 5498)

1 Filer or transmitter name and mailing address (number and street (including room or suite

number) or post office box, city, state, and ZIP code)

Federal identification number

(Enter a nine-digit number. Do not

enter a hyphen.)

Extension

Request for

Tax Year

19

Transmitter control code (IRS magnetic media filers only) 4 5

6 Check the boxes that apply. You need not enter the number of returns.

Type of Return Paper Returns Type of Return Paper Returns Magnetic Media* Type of Return Paper Returns Magnetic Media*

( ) ( ) ( ) ( ) ( ) ( )

W-2 1099-DIV 1099-PATR

1099-G 1099-R

1098 1099-INT 1099-S

1099-A 1099-MISC 5498

1099-B 1099-OID

W-2G

*Includes electronic filing.

7 State in detail why you need an extension. If you need more space, attach additional sheets.

Yes No

Signature © Title © Date ©

Cat. No. 10322N Form 8809 (Rev. 9-91)

Magnetic Media*

8

Paperwork Reduction Act Notice.—We

ask for the information on this form to

carry out the Internal Revenue laws of the

United States. You are required to give us

the information. We need it to ensure that

you are complying with these laws and to

allow us to figure and collect the right

amount of tax.

The time needed to complete and file

this form will vary depending on individual

Recordkeeping 36 min.

Learning about the law

or the form 14 min.

Preparing the form 48 min.

Copying, assembling, and

sending the form to the IRS 26 min.

If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form more

simple, we would be happy to hear from

you. You can write to both the Internal

Revenue Service, Washington, DC 20224,

Attention: IRS Reports Clearance Officer,

T:FP; and the Office of Management and

Budget, Paperwork Reduction Project

(1545-1081), Washington, DC 20503. DO

NOT send this form to either of these

offices. Instead, see Where To File, on

page 2.

circumstances. The estimated average time

is:

( )
Form 8809 (Rev. 9-91) Page 2

Filing Due Dates

Form Number

W-2

Note: Approval or denial notification will be

sent only to the person who requested the

extension (filer or transmitter).

1098

1099

5498

Item 2.—Enter your nine-digit Federal

employer identification number or social

security number if you are not required to

have an employer identification number.

Do not enter hyphens. A transmitter should

enter the transmitter’s Federal EIN in this

box. Failure to provide this number, or list

of numbers if you are acting as a

transmitter as explained under Item 1, will

result in automatic denial of the extension

request.

W-2G

Where To File.—Send Form 8809 to

Internal Revenue Service, Martinsburg

Computing Center, P.O. Box 1359,

Martinsburg, WV 25401-1359, or Internal

Revenue Service, Martinsburg Computing

Center, Route 9 and Needy Road,

Martinsburg, WV 25401.

Extension Period.—If your extension

request is approved, extension will be

granted for 30 days from the original due

date.

Item 3.—For magnetic media filers only,

enter your Transmitter Control Code (TCC).

This will apply only if you have filed Form

4419, Application for Filing Information

Returns Magnetically/Electronically, to file

Forms 1098, 1099, 5498, and/or W-2G,

with the IRS. The IRS Martinsburg

Computing Center assigns a five-character

TCC on approval of the Form 4419. See

Form 4419 for more information. Leave this

item blank if your extension request is for

filing paper forms, for filing Forms W-2, or

if you have not yet been assigned a TCC.

Additional extension.—If you need

additional time to file, you may request an

additional 30 days by submitting a letter

and attaching a copy of the first approval

letter you received from the IRS before the

end of the initial extension period.

Approval or Denial of Request.—

Requests for extensions of time to file

information returns are NOT automatically

granted. Approval or denial is based on

administrative criteria and guidelines. The

IRS will send you a letter of explanation

approving or denying your request.

Item 4.—Enter the name of someone who

is familiar with this request that the IRS

can contact if additional information is

required.

General Instructions

Purpose of Form.—Use this form to

request an extension of time to file Form

W-2, W-2G, 1098, 1099, or 5498. Note: Do

NOT use this form to request an extension

of time to furnish the statement to the

recipient or for an extension of time to file

Form 1040. For rules on extending the time

to file Form 1040, see the Form 1040

instructions.

Item 5.—Enter the telephone number,

including area code, of the person shown

in item 4.

Item 6.—Indicate the type(s) of information

returns for which you are requesting an

extension of time to file and how they will

be filed by checking the appropriate

box(es). For example, if you are requesting

an extension of time to file Forms

1099-INT on magnetic media, check the

box titled “Magnetic Media” beside the

block for 1099-INT.

Penalty.—If you file required information

returns late and you have not applied for

and received an approved extension of

time to file, you may be subject to a late

filing penalty. The amount of the penalty is

based on when you file the correct

information return. The penalty is:

Who May File.—Filers of returns submitted

on paper, on magnetic media, or

electronically may request an extension of

time to file on this form. A transmitter for

multiple filers may file this form but must

attach a list of the names, addresses, and

employer identification numbers of those

for whom they will be filing. Note: If you

are a magnetic media transmitter

requesting extensions of time for more than

50 payers, you are encouraged to submit

the extension requests on tape or diskette.

For more information, see Pub. 1220,

Specifications for Filing Forms 1098, 1099,

5498, and W-2G Electronically or on

Magnetic Tape, Tape Cartridge, and 5 1⁄4 -,

3 1⁄2 -, and 8-inch Magnetic Diskettes.

● $15 per information return if you

correctly file within 30 days (by March 30 if

the due date is February 28); maximum

penalty $75,000 per year ($25,000 for

certain small businesses).

● $30 per information return if you

correctly file more than 30 days after the

due date but by August 1; maximum

penalty $150,000 per year ($50,000 for

certain small businesses).

When To File.—The IRS encourages you

to file Form 8809 as soon as you know an

extension of time to file is necessary.

However, Form 8809 must be filed by the

due date of the returns. For example, a

request for an extension of time to file

Form 1099-INT, Interest Income, must be

filed (postmarked) by February 28. If you

are requesting an extension of time to file

several types of forms, you may use one

Form 8809, but you must file Form 8809

by the earliest due date. For example, if

you are requesting an extension of time to

file both Forms 1099-INT and Forms 5498,

Individual Retirement Arrangement

Information, you must file Form 8809 by

February 28. You may complete more than

one Form 8809 to avoid this problem. You

can request an extension for only 1 tax

year on this form. An extension cannot be

granted if a request is filed after the due

date of the original returns. Item 7.—Explain why you need an

extension of time to file your information

returns.

● $50 per information return if you file after

August 1 or you do not file required

information returns; maximum penalty

$250,000 per year ($100,000 for certain

small businesses).

Item 8.—Check the appropriate box to

indicate whether you will provide, or have

provided, a copy of the information return

or the required statement to the recipients

on time.

If you fail to file correct information

returns because of intentional disregard of

the filing and correct information

requirements, the minimum penalty is $100

per information return with no maximum

penalty.

Signature.—The extension request must

be signed by you or a person who is duly

authorized to sign a return, statement, or

other document.

Specific Instructions

Item 1.—Enter the name and complete

mailing address, including room or suite

number, of the filer requesting the

extension of time. If you act as transmitter

for a group of filers, enter the transmitter

name and address here, and attach a list

of filer names, addresses, and employer

identification numbers (EINs). Notify

Martinsburg Computing Center in writing of

any change in mailing address. Include a

copy of your original Form 8809.

Note: Failure to properly complete and sign

this form may cause delay in processing or

result in the denial of your request. Be sure

you are requesting an extension of time to

file only for returns listed on page 1.

Tax Year.—Enter the tax year for which

the extension is requested. If no year is

shown, the IRS will assume you are

requesting an extension for the returns

currently due to be filed.

Due Date

Last day of February

May 31

February 28

February 28

February 28

If any due date falls on a Saturday,

Sunday, or legal holiday, the due date is

extended to the next day that is not a

Saturday, Sunday, or legal holiday.

Note: You are required to file your

information returns on magnetic media if

you are required to file 250 or more

returns. See the Instructions for Forms

1099, 1098, 5498, and W-2G, and the

Instructions for Form W-2, for more

information about who is required to file on

magnetic media.

Note: If this extension request is approved,

it will only extend the due date for filing the

returns. It will not extend the due date for

furnishing the required copies or

statements to recipients.