EXTENSION OF TIME TO FILE 
 
                                          ACCOUNT NUMBER______________ 
                                                        
SSN#________________________________      FED. ID#__________________________________ 
 
NAME/COMPANY___________________________________________________________________ 
 
ADDRESS_________________________________________________________________________ 
 
CITY_____________________________   STATE________________    ZIP CODE________________ 

_______________________________________________ 
 
I hereby request an extension of time for filing my City Income Tax Return for: 
 
CALENDAR YEAR__________          FISCAL YEAR__________              Amount enclosed $_____________ 
 
                                                                                                                       Check Number ________________ 
 
CHECK APPROPRIATE LINE AND COMPLETE: 
            ____  Individual four (4) month extension to August _____ , 20_______ 
 
            ____  Individual additional extension to __________  ____ , 20_______ 
 
            ____  Calendar year six (6) month Corporate extension to September _____ , 20______ 
            
            ____  Calendar year six (6) month Partnership extension to Oct_____, 20______ 
 
            ____  Fiscal year six (6) month Corporate extension to ________________  ______ , 20_____ 

_______________________________________________ 
 
NOTE:  I understand that when I file a Warren City Extension, any amount due will be paid on or before      
            the filing deadline to avoid any interest or penalties.  Attach a copy of this city extension to the  
            return at the time of filing. 
          THIS IS NOT AN EXTENSION FOR PAYING THE TAX OWED. 
             
____________________________________                  ______________________________________ 
Signature of taxpayer                                date                    Signature of preparer                                    date 
                                                                                                 other than taxpayer 
____________________________________ 
Signature of spouse (if joint)                  date   
 
THIS EXTENSION WILL ONLY BE GRANTED IF PAYMENT IS REMITTED WITH THIS FORM.