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Arizona Form
Application for Electronic Filing of Extension Request
204-E For Calendar Year 2021 Individual Income Tax Returns Only 2021
Do not mail this form to the Arizona Department of Revenue. Retain with your tax records for a minimum of four (4) years.
Your estimated tax payment will be applied to your account.
Your First Name and Middle Initial Last Name Your Social Security Number
Enter
1
your
Spouse’s First Name and Middle Initial (if filing joint) Last Name Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route Apt. No. Daytime Phone (with area code)
2 94
City, Town or Post Office State ZIP Code
3
Resident Personal Income Tax Forms – Check only one box:
140 140A 140EZ 140PTC 140ET Part-Year Resident Personal Income Tax, Form 140PY
Nonresident Personal Income Tax, Form 140NR Nonresident Composite Income Tax, Form 140NR
All extension requests must be submitted on or before the original due date An Arizona extension cannot be granted for more than six months beyond
of the return, unless the original due date falls on a Saturday, Sunday, or the original due date of the return. Arizona will accept a valid federal
legal holiday. In that case, your request must be submitted on or before the extension for the period covered by the federal extension. This includes
business day following that Saturday, Sunday, or legal holiday. Your request the automatic six month federal extension.
for a 2021 filing extension must be submitted on or before April 18, 2022.
CHECK ONE BOX: Fiscal Tax Year Ending Return Due Date
Individual Calendar Year Filers: Because October 15, 2022 falls on a
Saturday, your extended due date is October 17, 2022.
This is a request for an automatic 6-month filing extension ................................. October 17, 2022
Individual Fiscal Year Filers:
Enter taxable year end date and 6-month extended due date ............................. M M D D Y Y Y Y M M D D Y Y Y Y
A federal extension will be used to file this tax return. This form is being used to transmit the Arizona extension payment.
1 Tax liability for 2021. You may estimate this amount ................................................................................... 1 00
2 Arizona income tax withheld during 2021 ................................................................... 2 00
3 Arizona estimated tax payments for 2021 .................................................................. 3 00
4 Credits you will claim on your 2021 return. See Form 301 for a list of credits ........... 4 00
5 Add lines 2 through 4 .................................................................................................................................... 5 00
6 Balance of Tax: Subtract line 5 from line 1 ................................................................................................. 6 00
7 Enter the amount of payment ....................................................................................................................... 7 00
You will be liable for the extension underpayment penalty if at least 90 percent of your tax liability disclosed by your return has not been paid by the original
due date of the return. You will be liable for the late payment penalty if you do not pay 100 percent of the tax shown on your return by the return’s original
due date. Interest accrues on any additional tax due from the original due date of the return until paid.
Making Your Payment: Individuals may make extension payments by direct debit, electronic check, or credit card.
Direct Debit of Payment: I authorize the Arizona Department of Revenue and its designated Financial Agent to initiate an ACH electronic
funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my Arizona taxes
owed on this return. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential
information necessary to answer inquiries and resolve issues related to the payment.
Foreign Account: Check this box if your direct debit of payment will ultimately come from a foreign account. If you check this box, do not
enter your routing or account numbers. If this box is checked, we cannot debit your payment. Instead, you must mail a check to the Arizona
Department of Revenue, PO Box 29085, Phoenix, AZ, 85038-9085.
Account information must be present when requesting direct debit. Direct Debit Payment Amount should equal amount on line 7.
TYPE OF ACCOUNT ROUTING NUMBER ACCOUNT NUMBER
Checking Savings
DIRECT DEBIT REQUEST DATE DIRECT DEBIT PAYMENT AMOUNT
M M D D Y Y Y Y $ .00
Electronic Payment From Your Checking or Savings Account: You can make a 2021 extension payment with an electronic payment from
your checking or savings account. There is no fee to use this method. To make an electronic payment, go to www.AZTaxes.gov and click on
the “Make a Payment” link. The “E-Check” option in the “Payment Method” drop-down box will debit the amount from the checking or savings
account that you specify. You will receive a confirmation number. Please keep this confirmation number as proof of payment.
Credit Card Payment: You can make a 2021 extension payment through a third-party service provider using your Visa, MasterCard, Discover
or American Express credit card. Go to www.AZTaxes.gov, click on the “Make a Payment” link; the credit card option will take you a third-party
vendor site. The provider will charge you a convenience fee based on the amount of your tax payment.
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