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                                    DELAWARE DIVISION OF REVENUE
 04                                 FORM 1100-P-EXT ā€“ DELAWARE ā€œSā€ CORPORATION REQUEST FOR EXTENSION                                                                                                                                                                                                         04 
 05                                 ACCOUNT NUMBER                     VERIFY BUSINESS FEIN                                           CALENDAR OR FISCAL YEAR ENDING                                DUE ON OR BEFORE                        VOUCHER                 EXTENSION TO                             05 
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 09                                                                                                                                                                                                                                                                                                          09 
 10          FILE THIS FORM IF EXTENSION IS REQUESTED                                                                               Check Here If A                                                                                                                                                          10 
 11                                                                                                                                 Request For            BALANCE DUE FROM LINE 3 OF WORKSHEET                                                                                                              11 
                                                                                                                                    Change Form Is
 12                                                                                                                                 Being Filed                                     (BALANCE OF TAX DUE FOR THE YEAR)                                                                                        12 
 13                                                                                                                                                                                                                                                                                                          13 
 14                                                                                                                                                        $                                                                                                                                                 14 
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 16                                                                                                                                                                                 *DF62115019999*                                                                                                          16 
 17                                                                                                                                                                                                                         DF62115019999                                                                    17 
 18                                                                                                                                                                                                 Mail This Form With Remittance Payable To:                                                               18 
             CHANGES MUST BE MADE ON THE REQUEST FOR CHANGE FORM.                                                                                                                                   Delaware Division of Revenue
 19          CHECK THE BOX IF YOU ARE FILING A CHANGE FORM.                                                                                                                                         P.O. Box 830, Wilmington, DE 19899-0830                                                                  19 
 20                                                                                                                                             TELEPHONE NUMBER                                                                            DATE                                                             20 
 21                                                                                                                                             EMAIL ADDRESS                                                                                                                                                21 
                                    X
 22                                 AUTHORIZED SIGNATURE    Iadeclaretrue, correctunderandpenaltiescompleteof perjuryreturn.that this is                                                                                                                                                                     22 
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