Form 05-164-A — Texas Franchise Tax Extension Request (Annual)

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Taxpayer number Due dateReport year State Country address has changed Blacken circle if this is a combined report City Taxpayer name Mailing address ZIP code plus 4 Blacken circle if the Tcode 13258 Annual 1. Extension payment 1.(Dollars and cents) Print or type name Area code and phone number ( ) - VE/DE PM Date (Rev.9-16/9) Texas Franchise Tax Extension Request If an online extension payment is made, the taxable entity should NOT submit a paper Extension Request (Form 05-164). If this extension is for a combined group, you must also complete and submit Form 05-165. Note to mandatory Electronic Fund Transfer(EFT) payers: I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief. Date Mail original to: Texas Comptroller of Public Accounts P.O. Box 149348 Austin, TX 78714-9348 Instructions for each report year are online at www.comptroller.texas.gov/taxes/franchise/forms. If you have any questions, call 800-252-1381. Taxpayers who paid $10,000 or more during the preceding fiscal year (Sept. 1 thru Aug. 31) are required to electronically pay their franchise tax. For more information visit www.comptroller.texas.gov/taxes/franchise/filing-requirements.php.