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4       State of Rhode Island Division of Taxation                                                                                                          4
5       Form BUS-EXT                                                                                                                                        5
6       Business Tax Automatic Extension Request                                          23111499990101                                                    6
7                                                                                                                                                           7
8  Name                                                                            Federal employer identification number                                   8
9                                                                                                                                                           9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                         99-9999999                                                               10
11 Address                                                                         For the period ending:                                                   11
12 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                         12/31/2023MM/DD/YYYY                                                     12
13 Address 2                                                                                                                                                13
14                                                                                                                                                          14
15                                                                                                                                                          15
   XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCity, town or post office State ZIP code E-mail address
16                                                                                                                                                          16
17 XXXXXXXXXXXXXXXXXXXXXXXXX XX                           99999                    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                          17
18                          This form must be completed and filed before the date prescribed for payment of the tax.                                        18
19                                                                                                                                                          19
20 Part 1:  Automatic extension                                                                                                                             20
21                                                                                                                                                          21
22 Check the box next to the form for which you are requesting an extension. Check only one box.                                                            22
23                                                                                                                                                          23
     Form RI-1065/RI-1120 - Rhode Island Corporate Income Tax                                                                      ELECTRONIC MANDATE 
24                                                                                                          The Rhode Island Division of Taxation24has an 
25                                                                                                          electronic mandate that requires Larger  25
26   Form RI-1120POL - Rhode Island Political Organization -6 month extension                               Business Registrants use electronic means26       to 
27                                                                                                          file returns and remit taxes beginning on  27
     Form T-72 - Rhode Island Public Service Corporation Gross Earnings - see below                         January 1, 2023.  
28                                                                                                                                                          28
29                                                                                                          For more information, refer to the instruc­29
30   Form T-74 - Rhode Island Banking Institution Excise -see below                                         tions for the form which you are making30this 
31                                                                                                          payment on Taxations’ website:                  31
     Form RI-PTE - Pass-Throughsee belowEntity Election -                                                   https://tax.ri.gov/forms 
32                                                                                                                                                          32
33                                                                                                          To file and pay, visit Taxation’s portal:  33
34                                  Automatic Extension      Periods                                        https://taxportal.ri.gov/                       34
35   Automatic six (6) month extension for calendar and fiscal year filers (except for filers with a                                                        35
                                                                                                            If you are not required to file and pay via  
36                          June 30 fiscal year end) of Form T-72, T-74 or RI-PTE.                          electronic means, send form and payment36         to: 
37 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                  37
38                                                                                                               One Capitol Hill                           38
39                                                                                                               Providence, RI 02908                       39
40 Part 2:  Amount due with extension                                                                                                                       40
41                                                                                                                                                          41
42 1 Estimated tax due for the current year..................................................................................... 1 9999999999 99            42
43                                                                                                                                                          43
44 2 Carry forward and estimated payments paid to date...............................................................            2 9999999999 99            44
45                                                                                                                                                          45
46 3 Balance due with extension request.  Subtract line 2 from line 1............................................                3 9999999999 99            46
47                                                                                                                                                          47
48 4 Amount paid with extension request........................................................................................  4 9999999999 99            48
49                                                                                                                                                          49
50                                                                                                                                                          50
                                    NOTE: If payment is made online, you do not need to send this form in.  
51                        For more information about Taxation’s portal, visit:  https://tax.ri.gov/online-services/tax-portal                               51
52                                                                                                                                                          52
   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 
53 belief, it is true, accurate and complete  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge 53
54  Authorized officer signature                        Print name                              Date                             Telephone number           54
55                                         XXXXXXXXXXXXXXXXXXXXX 12/31/2022                               (999) 999-9999                                    55
56  Paid preparer signature                             Print name                              Date                             Telephone number           56
57                                                                                                                                                          57
58                                         XXXXXXXXXXXXXXXXXXXXX 12/31/2022                               (999) 999-9999                                    58
59  Paid preparer address                       City, town or post office    State           ZIP Code                                        PTIN           59
60 XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX                                  XX       99999                  P99999999                                         60
61                                                                                                                                                          61
62                 May the Division of Taxation contact your preparer?   YES                                                                                62
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                                                                                                                                                  11/2023






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