Form F-7004 — Florida Tentative Income/Franchise Tax Return and Application for Extension of Time to File Return

Rule 12C-1.051 Florida Department of Revenue - Corporate Income Tax

Florida Administrative Code

Effective 01/17

R. 01/17

Florida Tentative Income / Franchise Tax
TC

# Return and Application for Extension of Time to File Return

If typing, type through the boxes.
0 1 2 3 4 5 6 7 8 9
You must write within the boxes.
(example)
Write your numbers as shown and enter one number per box.
Name
Address
City/St
ZIP
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this application, and that to the best of my knowledge and belief the statements herein are true and correct:
Sign here: ____Date:
(example)
FEIN
1065 1120S
Taxable year end:
Type of federal return to be filed
Y

M M D D Y
(Mark "X" in one box only)
All other federal returns to be filed

US DOLLARS CENTS
Tentative tax due (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135 9100 0 20239999 0002005030 9 3999999999 0000 2

Rule 12C-1.051 Florida Department of Revenue - Corporate Income Tax

Florida Administrative Code

Effective 01/17

R. 01/17

Florida Tentative Income / Franchise Tax
TC

# Return and Application for Extension of Time to File Return

0 1 2 3 4 5 6 7 8 9
If typing, type through the boxes.
You must write within the boxes.
(example)
Write your numbers as shown and enter one number per box.
Name
Address
City/St
ZIP
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this application, and that to the best of my knowledge and belief the statements herein are true and correct:
Sign here: ____Date:
(example)
FEIN
Taxable year end: 1065 1120S
Type of federal return to be filed
Y

M M D D Y
(Mark "X" in one box only)
All other federal returns to be filed

US DOLLARS CENTS
Tentative tax due (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135 9100 0 20239999 0002005030 9 3999999999 0000 2

Rule 12C-1.051 Florida Department of Revenue - Corporate Income Tax

Florida Administrative Code

Effective 01/17

R. 01/17

Florida Tentative Income / Franchise Tax
TC

# Return and Application for Extension of Time to File Return

If typing, type through the boxes.
0 1 2 3 4 5 6 7 8 9
You must write within the boxes.
(example)
Write your numbers as shown and enter one number per box.
Name
Address
City/St
ZIP
Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this application, and that to the best of my knowledge and belief the statements herein are true and correct:
Sign here: ____Date:
(example)
FEIN
Taxable year end:
1065 1120S
Type of federal return to be filed
Y

M M D D Y
(Mark "X" in one box only)
All other federal returns to be filed

US DOLLARS CENTS
Tentative tax due (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135 9100 0 20239999 0002005030 9 3999999999 0000 2

# Information for Filing Florida Form F-7004

When to file — File this application on or before the original due date of the taxpayer's corporate income tax or partnership return. Do not file before the end of the tax year.
To file online go to www.floridarevenue.com
Penalties —If you are required to pay tax with this application, failure to pay all taxes due will void any extension of time and subject the taxpayer to penalties and interest. There is also a penalty for a late-filed return when no tax is due.
Signature — A person authorized by the taxpayer must sign Florida Form F-7004.
They must be: an officer or partner of the taxpayer; a person currently enrolled to practice before the Internal Revenue Service (IRS); or an attorney or Certified Public Accountant qualified to practice before the IRS under Public Law 89-332.
The Florida Form F-7004 must be filed - To receive an extension of time to file your Florida return, Florida Form F-7004 must be timely filed, even if you have already filed a federal extension request. A federal extension by itself does not extend the time to file a Florida return.
An extension for Florida tax purposes may be granted, even though no federal extension was granted. See Rule 12C-1.0222, F.A.C., for information on the requirements that must be met for your request for an extension of time to be valid.

# R. 01/17

A. If applicable, state the reason you need the extension:

B. Type of federal return filed:__
Contact person for questions:__
Telephone number: (_) _
Contact person email address:__

Text version of this table

Extension of Time Request	Florida Income/ Franchise Tax Due
1. Tentative amount of Florida tax for the taxable year	1.
2. LESS: Estimated tax payments for the taxable year	2.
3. Balance due — You must pay 100% of the tax tentatively determined due with this extension request.	3.

Text version of this table

Extension of Time Request	Florida Income/Fran chise Tax Due
1. Tentative amount of Florida tax for the taxable year	1.
2. LESS: Estimated tax payments for the taxable year	2.
3. Balance due — You must pay 100% of the tax tentatively determined due with this extension request.	3.

# Franchise Tax Due

1.

Text version of this table

Extension of Time Request	Florida Income/ Franchise Tax Due
1. Tentative amount of Florida tax for the taxable year	1.
2. LESS: Estimated tax payments for the taxable year	2.
3. Balance due — You must pay 100% of the tax tentatively determined due with this extension request.	3.

Transfer the amount on Line 3 to Tentative tax due on reverse side.

# Information for Filing Florida Form F-7004

When to file — File this application on or before the original due date of the taxpayer's corporate income tax or partnership return. Do not file before the end of the tax year.
To file online go to www.floridarevenue.com
Penalties —If you are required to pay tax with this application, failure to pay all taxes due will void any extension of time and subject the taxpayer to penalties and interest. There is also a penalty for a late-filed return when no tax is due.
Signature — A person authorized by the taxpayer must sign Florida Form F-7004.
They must be: an officer or partner of the taxpayer; a person currently enrolled to practice before the Internal Revenue Service (IRS); or an attorney or Certified Public Accountant qualified to practice before the IRS under Public Law 89-332.
The Florida Form F-7004 must be filed - To receive an extension of time to file your Florida return, Florida Form F-7004 must be timely filed, even if you have already filed a federal extension request. A federal extension by itself does not extend the time to file a Florida return.
An extension for Florida tax purposes may be granted, even though no federal extension was granted. See Rule 12C-1.0222, F.A.C., for information on the requirements that must be met for your request for an extension of time to be valid.

# R. 01/17

A. If applicable, state the reason you need the extension:

B. Type of federal return filed:__
Contact person for questions:__
Telephone number: (_) _
Contact person email address:__
Florida Income/Fran-

# Extension of Time Request chise Tax Due

1.

Tentative amount of Florida tax for the taxable year 2.
LESS: Estimated tax payments for the taxable year
Balance due — You must pay 100% of the tax 3. tentatively determined due with this extension request.

Transfer the amount on Line 3 to Tentative tax due on reverse side.

# Information for Filing Florida Form F-7004

When to file — File this application on or before the original due date of the taxpayer's corporate income tax or partnership return. Do not file before the end of the tax year.
To file online go to www.floridarevenue.com
Penalties —If you are required to pay tax with this application, failure to pay all taxes due will void any extension of time and subject the taxpayer to penalties and interest. There is also a penalty for a late-filed return when no tax is due.
Signature — A person authorized by the taxpayer must sign Florida Form F-7004.
They must be: an officer or partner of the taxpayer; a person currently enrolled to practice before the Internal Revenue Service (IRS); or an attorney or Certified Public Accountant qualified to practice before the IRS under Public Law 89-332.
The Florida Form F-7004 must be filed - To receive an extension of time to file your Florida return, Florida Form F-7004 must be timely filed, even if you have already filed a federal extension request. A federal extension by itself does not extend the time to file a Florida return.
An extension for Florida tax purposes may be granted, even though no federal extension was granted. See Rule 12C-1.0222, F.A.C., for information on the requirements that must be met for your request for an extension of time to be valid.

# R. 01/17

A. If applicable, state the reason you need the extension:

B. Type of federal return filed:__
Contact person for questions:__
Telephone number: (_) _
Contact person email address:__

# Franchise Tax Due

1.

Tentative amount of Florida tax for the taxable year 2.
LESS: Estimated tax payments for the taxable year
Balance due — You must pay 100% of the tax 3. tentatively determined due with this extension request.

Transfer the amount on Line 3 to Tentative tax due on reverse side.