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-1165 
 
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