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Form    4768                Application for Extension of Time To File a Return and/or 
                                                                                                                                                            OMB No. 1545-0181 
(Rev. August 2012)          Pay U.S. Estate (and Generation-Skipping Transfer) Taxes
Department of the Treasury  
Internal Revenue Service 
Part I      Identification
Decedent’s first name and middle initial                 Decedent’s last name                                                                 Date of death 

Name of executor                                         Name of application filer (if other than the executor)                               Decedent’s social security number 

Address of executor                                                         (Number, street, and room or suite no.)                           Estate tax return due date 

City, state, and ZIP code                                Domicile of decedent (county, state, and ZIP code)                                   Daytime telephone number 

Part II     Extension of Time To File Form 706, 706-A, 706-D, 706-NA, or 706-QDT (Section 6081)
                                                           Automatic Extension 
If you are applying for an automatic 6-month extension of time to file: 
• Form 706, check here           .       . .     . . . . . . .          . . . . .                                   . . .   . . . .     . . . . . .    .    . .  .    .  ▶
• Form 706-A, 706-D, 706-NA, or 706-QDT, indicate the form by checking the appropriate box below. 
        Form 706-A               Form 706-D                Form 706-NA                                                Form 706-QDT 
                                                           Additional Extension 
If you are an executor out of the country applying for an extension of time to file in excess of 6 months, check here  .                               .    . .  .    .  ▶
Also you must    attach a statement explaining in detail why it is impossible or impractical to file Form                                   Enter extension date requested 
706 by the due date. See instructions. 
Part III    Extension of Time To Pay (Section 6161)
                                                                                                                                            Enter extension date requested   
You must attach your written statement to explain in detail why it is impossible or impractical to                                          (Not more than 12 months) 
pay the full amount of the estate (or GST) tax by the return due date. If the taxes cannot be determined 
because the size of the gross estate is unascertainable, check here         © and enter “-0-” or other 
appropriate amount on Part IV, line 3. You must attach an explanation. 
• If this request is for the tax that will be or was due with the filing of Form 706, check here .                              . .     . . . . . .    .    . .  .    .  ▶
• If this request is for the tax that will be due as a result of an amended or supplemental Form 706, check here                                . .    .    . .  .    .  ▶
• If this request is for additional tax due as a result of an examination of your Form 706, check here  .                                 . . . . .    .    . .  .    .  ▶
• If this request is for a section 6166 installment payment, check here   .     .                                   . . .   . . . .     . . . . . .    .    . .  .    .  ▶
Part IV     Payment To Accompany Extension Request
1       Amount of estate and GST taxes estimated to be due  .             . . . .                                   . . .   . . . .     . .   1 
2       Amount of cash shortage (complete Part III)  .     . .          . . . . .                                   . . .   . . . .     . .   2 
3       Balance due (subtract line 2 from line 1) (see instructions) .      . . .                                   . . .   . . . .     . .   3 
                                                         Signature and Verification 
If filed by executor—Under penalties of perjury, I declare that I am an executor of the estate of the above-named decedent and that  
to the best of my knowledge and belief, the statements made herein and attached are true and correct. 

                            Executor’s signature                                                                      Title                                 Date 
If filed by someone other than the executor—Under penalties of perjury, I declare that to the best of my knowledge and belief, the 
statements made herein and attached are true and correct, that I am authorized by an executor to file this application, and that I am 
(check box(es) that apply(ies)): 
  A member in good standing of the bar of the highest court of (specify jurisdiction) ▶
  A certified public accountant duly qualified to practice in (specify jurisdiction) ▶
  A person enrolled to practice before the Internal Revenue Service. 
  A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested.) 

                            Filer’s signature (other than the executor)                                                                           Date 
For Paperwork Reduction Act Notice, see separate instructions.                                                          Cat. No. 41984P             Form  4768  (Rev. 8-2012) 

Form 4768 (Rev. 8-2012)                                                                      Page  2 
Decedent’s first name and middle initial Decedent’s last name                     Decedent’s social security number 

Part V        Notice to Applicant—To be completed by the Internal Revenue Service 
Note. If applying for an extension of time to pay, file this page in duplicate.  
      The application for extension of time to pay (Part III) is: 
              Approved 

              Not approved because (see instructions for your appeal rights) 

              Other 

Internal Revenue Service official        Address                                  Date 

Name (print) 

Title (print) 

Signature: 
                                                                                  Form  4768  (Rev. 8-2012)