Electronic Filing or Electronic Payment
                                        Waiver Request
      Request for E-File Waiver

      Request for Electronic Funds Transfer Waiver

 Legal Name / Business Name                                        Wis. Tax Number (WTN)

 Mailing Address                                                   Type of Tax / Return

 City                                   State                   Zip

1.  Describe the undue hardship to e‑filing your return and include a detailed computation of any additional 
 costs to complying with the e‑filing requirement.

2.  Identify the steps you have taken to timely e‑file and why the steps were unsuccessful.

3.  Explain the steps you will take to assure future e‑filing.

Under penalties of law, I declare that the information contained in this waiver request is true, correct and complete to 
the best of my knowledge.
 Signature of taxpayer or officer authorized to sign the return                       Date

Allow 60 days from time of filing waiver request for processing of the waiver request.

Place for filing:  Wisconsin Department of Revenue
Address:          PO Box 8949
                  Madison WI  53708‑8949

FAX Number:       (608) 267‑1030

EFT-102 (N. 3-10)                                                                          Wisconsin Department of Revenue