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DELAWARE DIVISION OF REVENUE
04 FORM 1100-T-EXT – DELAWARE CORPORATE INCOME TAX 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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10 FILE THIS FORM IF EXTENSION IS REQUESTED Check Here If A 10
11 Request For BALANCE DUE FROM LINE 5 OF WORKSHEET 11
Change Form Is
12 Being Filed (BALANCE OF TAX DUE FOR THE YEAR) 12
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14 $ 14
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16 *DF62415019999* 16
17 DF62415019999 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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