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

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 (Rev. March 1995) (For Forms W-2, W-2G, 1042-S, 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) (Please type or print clearly.)

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/electronic filers only) 4 5

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

Form Check here Form Check here Form Check here

( ) ( )

W-2 1099-C 1099-PATR

1099-R

1099-G

1098

1099-S

1099-INT

1099-A

5498

1099-MISC

1099-B 1099-OID

W-2G

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

Signature © Title © Date ©

Cat. No. 10322N Form 8809 (Rev. 3-95)

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

circumstances. The estimated average time

is:

Recordkeeping 31 min.

Learning about the law

or the form 14 min.

Preparing the form 51 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 simpler,

we would be happy to hear from you. You

can write to the Internal Revenue Service,

Attention: Tax Forms Committee, PC:FP,

Washington, DC 20224. DO NOT send the

form to this address. Instead, see Where

To File on page 2.

( )

6 Enter total number of filers for which this request is made (Complete only if you are a transmitter requesting an extension

for more than one filer. You must attach a list of the names and employer identification numbers of such filers. If you are

making the request for 10 or more filers, see the Note under Who May File on page 2.) ©

7 Check this box only if you received an original extension and you now need an additional extension. (See instructions.) ©

1099-DIV

( )

1042-S
Form 8809 (Rev. 3-95) 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

Line 2.—Enter your nine-digit Federal EIN

or social security number if you are not

required to have an EIN. 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 Line 1, will result in

automatic denial of the extension request.

W-2G

Where To File.—Send Form 8809 to

IRS-Martinsburg Computing Center, P.O.

Box 1359, Martinsburg, WV 25401-1359,

or IRS-Martinsburg Computing Center,

Information Reporting Program, Route 9

and Needy Road, Martinsburg, WV 25401.

Extension Period.—If the IRS approves your

extension request, you will be granted an

extension of 30 days from the original due

date.

Line 3.—For magnetic media or electronic

filers only. If you filed Form 4419,

Application for Filing Information Returns

Magnetically/Electronically, to file Forms

1042-S, 1098, 1099, 5498, or W-2G, and it

was approved, the IRS-Martinsburg

Computing Center assigned you a

five-character Transmitter Control Code

(TCC). Enter that TCC here. Leave this item

blank if (1) you are requesting an extension

to file Forms W-2, (2) you are requesting

an extension to file forms on paper, or (3)

you have not yet received your TCC.

Additional extension.—If you need

more time to file, you may request an

additional 30 days by submitting another

Form 8809 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.

Line 4.—Enter the name of someone who

is familiar with this request whom 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, 1042-S, 1098, 1099, or 5498.

Note: Do not use this form to request an

extension of time to (1) provide statements

to recipients, (2) file Form 1042 (use Form

2758), or (3) file Form 1040 (use Form

4868).

Line 5.—Enter the telephone number,

including area code, of the person shown

in line 4.

Line 8.—Indicate the information returns

for which you are requesting an extension

of time to file by checking the appropriate

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

an extension of time to file Forms

1099-INT, check the box beside Form

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 and employer

identification numbers of those for whom

they will be filing.

● $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 suggests that you

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.

Line 9.—Explain why you need an

extension of time to file.

● $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).

If you intentionally do not file correct

information returns, 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

Line 1.—Enter the name and complete

mailing address, including room or suite

number, of the filer requesting the

extension of time. Use the name and

address you use on other tax returns you

file with the IRS. If you act as transmitter

for a group of filers, enter the transmitter

name and address here, and attach a list

of filer names and employer identification

numbers (EINs). Notify IRS-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 in line 8.

Tax Year.—Enter the tax year for which

the extension is requested. If no tax 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

the next business day.

Note: If you are required to file 250 or

more returns, you must file them

magnetically or electronically. See the

Instructions for Forms 1099, 1098, 5498,

and W-2G, the Instructions for Form W-2,

and the Instructions for Form 1042-S, for

more information.

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

providing statements to recipients.

Note: If you are a magnetic media

transmitter requesting extensions of time to

file for more than 50 filers, you must

submit the extension requests magnetically

or electronically. Although not required, if

you are requesting extensions of time for

10 or more filers, you are encouraged to

submit the extension requests magnetically

or electronically. For more information, see

Pub. 1220, Specifications for Filing Forms

1098, 1099, 5498 and W-2G Magnetically

or Electronically.

Line 6.—For transmitters requesting an

extension for two or more filers, enter the

number of filers. Be sure to attach the

required list. All others should leave this

box blank.

Line 7.—Check this box to tell the IRS you

have already received at least one

extension, but you need an additional

extension for the same year and for the

same forms. Do not check this box unless

you received an original extension. A small business is a firm with average

annual gross receipts of $5 million or less

for the 3 most recent tax years.

Printed on recycled paper

1042-S March 15