State of Rhode Island Division of Taxation 
     Form BUS-EXT 
     Business Tax Automatic Extension Request                                    23111499990101

Name                                                                    Federal employer identification number

Address                                                                 For the period ending:
                                                                                           MM/DD/YYYY
Address 2

City, town or post office                   State      ZIP code         E-mail address

                          This form must be completed and filed before the date prescribed for payment of the tax.
Part 1:  Automatic extension

Check the box next to the form for which you are requesting an extension. Check only one box.  

  Form RI-1065/RI-1120 - Rhode Island Corporate Income Tax                                                                     ELECTRONIC MANDATE 
                                                                                                      The Rhode Island Division of Taxation has an 
                                                                                                      electronic mandate that requires Larger  
  Form RI-1120POL - Rhode Island Political Organization - 6 month extension                           Business Registrants use electronic means to 
                                                                                                      file returns and remit taxes beginning on  
  Form T-72 - Rhode Island Public Service Corporation Gross Earnings - see below                      January 1, 2023.  
                                                                                                       
                                                                                                      For more information, refer to the instruc­
  Form T-74 - Rhode Island Banking Institution Excise - see below                                     tions for the form which you are making this 
                                                                                                      payment on Taxations’ website: 
  Form RI-PTE - Pass-Throughsee belowEntity Election -                                                https://tax.ri.gov/forms 
                                                                                                       
                                                                                                      To file and pay, visit Taxation’s portal:  
                              Automatic Extension      Periods                                        https://taxportal.ri.gov/ 
  Automatic six (6) month extension for calendar and fiscal year filers (except for filers with a      
                                                                                                      If you are not required to file and pay via  
                          June 30 fiscal year end) of Form T-72, T-74 or RI-PTE.                      electronic means, send form and payment to: 
Automatic seven (7) month extension for June 30 year end filers of Form T-72 or T-74 or RI-PTE             R.I. Division of Taxation 
                                                                                                           One Capitol Hill 
                                                                                                           Providence, RI 02908
Part 2:  Amount due with extension

1 Estimated tax due for the current year..................................................................................... 1

2 Carry forward and estimated payments paid to date...............................................................            2

3 Balance due with extension request.  Subtract line 2 from line 1............................................                3

4 Amount paid with extension request........................................................................................  4

                              NOTE: If payment is made online, you do not need to send this form in.  
                       For more information about Taxation’s portal, visit:  https://tax.ri.gov/online-services/tax-portal
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
belief, it is true, accurate and complete  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge
 Authorized officer signature               Print name                               Date                                     Telephone number

 Paid preparer signature                    Print name                               Date                                     Telephone number

 Paid preparer address               City, town or post office    State           ZIP Code                                                PTIN

         May the Division of Taxation contact your preparer?   YES

                                                                                                                                               Revised 
                                                                                                                                              11/2023