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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 DateIndividual 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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