L-4868                                                            LANSING                                                       2015 RET REX
                                           APPLICATION FOR AUTOMATIC EXTENSION OF TIME
                                                        TO FILE AN INDIVIDUAL INCOME TAX RETURN

Taxpayer Name:

Social Security No:

Due on or Before:         4/30/2016, due date of 2015 return

Payment:                                  $

Payment Method:           ∎               Make payment by check or money order payable to "City of Lansing."  DO NOT SEND CASH.
                          ∎               Write your Soc. Sec. No., daytime phone number, and "2015 L-4868" on your check or money order.
                          ∎ To pay by credit card or direct debit, see income tax website of the City of Lansing (www.lansingmi.gov)

Address for Payment: City of Lansing Income Tax Division
                          PO Box 40756
                          Lansing, MI  48901

Instructions:             ∎               An extension to file does not extend the time to pay the tax due.  Tax paid late will be assessed late fees.
                          ∎               Line 1:  Enter the total tax liability you expect to report on your 2015 Form L-1040, page 1, line 23.
                          ∎               Line 2:  Enter the total payments that you expect to report on your 2015 Form L-1040, page 2, line 4, not
                                          including the extension payment payment reported on line 3 of this form.
                          ∎               Filing Date:  The Income tax ordinance limits an extension to SIX months from the original due date.
Related Information:      ∎               Federal extension:  Filing a federal extension (Form 4868) with the Internal Revenue Service does not 
                                          grant an extension of time to file a Lansing income tax return.
                          ∎ Persons living outside the United States:  Where the Internal Revenue Code grants an automatic two-
                                          month extension to persons living outside the U.S., an automatic two-month extension will be granted.

Payment:                  ∎ An extension is automatically granted upon payment of the balance due (line 3); failure to pay the balance 
                                          due invalidates the extension request; an extension filed without a payment will be not accepted.
                          ∎ Interest and penalty will be assssed on taxes paid late even if an extension of time to file is granted.
                          ∎ Penalty may be waived by the Income Tax Administrator if the tax paid by the original due date is not under
                                          stated by more than 5% of tax or the taxpayer can show that the failure to pay on time was due to
                                          reasonable cause.
Taxpayer Records:         Amount Paid:                            Check Number:                                                 Date Mailed:  

                                                                                                                                Revised: 01/12/2016
        KEEP TOP PORTION FOR YOUR RECORDS.  SEND BOTTOM PORTION WITH YOUR PAYMENT 
                                                                 v   DETACH HERE  v
                                                                  LANSING                                                       Revised: 01/12/2016
L-4868                                                                                                                          2015 RET REX
         APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO FILE AN INDIVIDUAL INCOME TAX RETURN
                                                                 Mail To: Lansing Income Tax Division
NACTP #                                                           PO Box 40756
EFIN #                                                           Lansing, MI 48901
Taxpayer's first name, initial, last name                        Taxpayer's SSN

If joint return spouse's first name, initial, last name          If joint payment, spouse's SSN

Present home address (Number and street)                Apt. no. {2D Barcode of scan line data}

Address line 2 (P.O. Box address for mailing use only)

City, town or post office                  State        Zip code

Foreign country name, province/county, postal code               Amount of estimated tax you are paying by check or money order Round to nearest dollar
                                                                                                                                                       .00