40A102 (09-2016)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE 2016
APPLICATION FOR EXTENSION OF TIME TO FILE
COMPLETE ONLY IF NOT FILING FEDERAL EXTENSION
Ø INDIVIDUAL, GENERAL PARTNERSHIP AND
Ø SEE INSTRUCTIONS FOR PAYMENT REQUIREMENTS FIDUCIARY INCOME TAX RETURNS FOR KENTUCKY
Use this form if you are requesting a Kentucky extension of time to file. Taxpayers who request a federal extension are not required to file a
separate Kentucky extension. The requirements may be met by attaching federal Form 4868 (automatic extension) to the Kentucky return.
Beginning this year, you may choose to electronically file your Kentucky extension for Individual returns. Filing electronically also allows you
the option to pay electronically through a direct debit transaction scheduled on or before April 18, 2017.
All taxpayers filing this Application of Extension must complete Sections I and the Payment Voucher. If no payment is being remitted, leave
amount paid boxes on the Payment Voucher blank. If you are filing your Application of Extension electronically and chose to pay by direct
debit, complete Section II with your banking information.
You will be notified only if the application for extension is denied. To avoid the late filing penalty, a copy of this form must be attached to your
return when filed. Keep a copy for yourself.
Section I
A six-month extension is requested for filing the income tax return of the taxpayer(s) listed below for the taxable year ended ______________.
REASON FOR REQUEST (A reason must be given before any request can be considered. Inability to pay tax liability is not a valid reason.)
Signature of Taxpayer Date Signature of Paid Preparer Date
Ø Mail to: Kentucky Department of Revenue P.O. Box 1190 Frankfort, KY 40602-1190 ×
DENIED: Late (postmarked after return date) Other:
Section II - Direct Debit of Tax Due (Complete only if filing electronic extension)
The first 2 numbers of the RTN must be
Routing Transit number (RTN) 01 through 12 or 21 through 32.
Depositer account number (DAN)
Type of account: Savings Checking Type of account: Savings Checking Tax due debit amount $ Debit date __ __ / __ __ / __ __ __ __Tax due debit amount $ Debit date __ __ / __ __ / __ __ __ __
I authorize the Kentucky Department of Revenue and its designated Financial Agent to initiate an ACH electronic funds withdrawal entry to the financial institution account
indicated above for payment of my state taxes owed and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until
I notify the Kentucky Department of Revenue to terminate the authorization. To revoke (cancel) a payment, I must contact the Kentucky Department of Revenue at (502)
564-4581 no later than 2 business days prior to the payment (debit) date. 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 payment.
Ø Ø
Your Signature (If joint or combined return, both must sign) Spouse's Signature Date
Detach here and mail voucher with your payment
40A102 (09/16) Kentucky Extension Payment Voucher 2016
AAAB AAB AAAAB AAAB AAB AAAAB
12/31/2016
CCCD CCD CCCCD CCCD CCD CCCCD Year Ending
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAABYour Social Security No. / FEIN Spouse's Social Security No.
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCD
LAST NAME FIRST NAME SPOUSE'S NAME
AAAAAAAAAB
Amount Paid 0 0
EFCEFCEFCD
Mailing Address (Number and Street including Apartment No. or P.O. Box)
Make check payable to: Kentucky State Treasurer.
City, Town or Post Office State Zip Code
Check type of return:
Individual Fiduciary Mail to: 40A1020003
General Partnership Kentucky Department of Revenue
For informational purposes only. P.O. Box 1190
General Partnerships DO NOT have a tax liability. Frankfort, KY 40602-1190
DO NOT ATTACH CHECK TO VOUCHER 40A102 (09/16)