City of Ionia                                     P.O. Box 512 
Income Tax Division                                   Ionia, MI  48846 
                                                  616-523-0142 

           APPLICATION FOR AUTOMATIC EXTENSION OF TIME 
                       TO FILE CITY OF IONIA INCOME TAX RETURN 

Prepare this form in duplicate.  File the original with the City of Ionia Income Tax Division on or 
before the due date for filing a return.  When the original is filed, it may be assumed that the 
extension is automatically granted unless otherwise notified.  Attach the duplicate to your City of 
Ionia Income Tax Return.  Please attach a copy of your Federal extension application. 

Name                                      Social Security Number or Employer ID number               

Number and Street                                      Check type of return to be filed 
                                                              Form I-1040 
                                                      Form  I-1120  
                                                      Form I-1065 

City, State & Zip Code 

Reason for request 

The Uniform City Income Tax Ordinance limits the extension of time for filing annual returns to six 
months from the original due date. 
A ___ month extension of time until ______________________20__ is hereby requested in which 
to file the Ionia Income Tax Return of the above for the taxable year beginning_______20___ and 
ending___________20____. 

                                        TENTATIVE TAX 
THE TAX TENTATIVELY DETERMINED TO BE DUE MUST BE PAID WITH THIS 
EXTENSION. 

1. Tentative City of Ionia Tax                         ___________ 
2. Less a) Estimated tax payments made                 ___________ 
     b) withholdings                                   ___________ 
     c) other credits ______________                   ___________ 
3. Balance Due                                         ___________ 

Signature of taxpayer, officer or agent                  Date 

Mail to:  City of Ionia Income Tax Division, PO Box 512, Ionia, MI 48846