Form F-7004 Fillable Tentative Income/Franchise Tax Return and Application for Extension of Time to File Return R.01/14
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Mark X in (Mark X in (See reverse side) (See reverse side) 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 1 Tentative amount of Florida tax for the taxable year 1 1 Tentative amount of Florida tax for the taxable year 1 2 LESS: Estimated tax payments for the taxable year 2 2 LESS: Estimated tax payments for the taxable year 2 3 Balance due You must pay 100% of the tax 3 Balance due You must pay 100% of the tax 9200 0 20139999 0002005030 9 3999999999 0000 2 9200 0 20139999 0002005030 9 3999999999 0000 2 a federal extension request A federal extension by itself does not extend the time to a federal extension request A federal extension by itself does not extend the time to A If applicable state the reason you need the extension: A If applicable state the reason you need the extension: Accountant qualified to practice before the IRS under Public Law 89 332 Accountant qualified to practice before the IRS under Public Law 89 332 Address Address An extension for Florida tax purposes may be granted even though no federal An extension for Florida tax purposes may be granted even though no federal application and that to the best of my knowledge and belief the statements herein are true and correct: Check here if you transmitted application and that to the best of my knowledge and belief the statements herein are true and correct: Check here if you transmitted B Type of federal return filed: B Type of federal return filed: City/St/ZIP City/St/ZIP Contact person for questions: Contact person for questions: corporate income tax or partnership return Do not file before the end of the tax year corporate income tax or partnership return Do not file before the end of the tax year Corporation Partnership Corporation Partnership Effective 01/14 Effective 01/14 Extension of Time Request Florida Income/Franchise Extension of Time Request Florida Income/Franchise extension was granted See Rule 12C 1 0222 F A C for information on the extension was granted See Rule 12C 1 0222 F A C for information on the F 7004 F 7004 F 7004 failure to pay will void any extension of time and subject the taxpayer to penalties and failure to pay will void any extension of time and subject the taxpayer to penalties and file a Florida return file a Florida return FILING STATUS FILING STATUS Florida Administrative Code Florida Administrative Code Florida Department of Revenue Corporate Income Tax Florida Department of Revenue Corporate Income Tax Florida return Florida Form F 7004 must be timely filed even if you have already filed Florida return Florida Form F 7004 must be timely filed even if you have already filed Florida Tentative Income / Franchise Tax Florida Tentative Income / Franchise Tax for a late filed return when no tax is due for a late filed return when no tax is due funds electronically funds electronically If typing type through the boxes 0123456789 (example) (example) If typing type through the boxes 0123456789 (example) (example) Information for Filing Florida Form F 7004 F 7004 Information for Filing Florida Form F 7004 F 7004 interest for failure to file a timely return(s) and pay all taxes due There is also a penalty interest for failure to file a timely return(s) and pay all taxes due There is also a penalty M M D D Y Y M M D D Y Y Make checks payable to and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399 0135 Make checks payable to and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399 0135 one box only) one box only) Penalties for failure to pay tax If you are required to pay tax with this application Penalties for failure to pay tax If you are required to pay tax with this application practice before the Internal Revenue Service (IRS) or (c) an attorney or Certified Public practice before the Internal Revenue Service (IRS) or (c) an attorney or Certified Public R 01/14 R 01/14 R 01/14 requirements that must be met for your request for an extension of time to be valid requirements that must be met for your request for an extension of time to be valid Return and Application for Extension of Time to File Return Return and Application for Extension of Time to File Return Rule 12C 1 051 Rule 12C 1 051 Sign here: Date: Sign here: Date: Signature A person authorized by the taxpayer must sign Florida Form F 7004 Signature A person authorized by the taxpayer must sign Florida Form F 7004 Tax Due Tax Due Taxable year end: Taxable year end: Telephone number: ( ) Telephone number: ( ) Tentative tax due Tentative tax due tentatively determined due with this extension request tentatively determined due with this extension request The Florida Form F 7004 must be filed To receive an extension of time to file your The Florida Form F 7004 must be filed To receive an extension of time to file your They must be (a) an officer or partner of the taxpayer (b) a person currently enrolled to They must be (a) an officer or partner of the taxpayer (b) a person currently enrolled to To file online go to www myflorida com/dor To file online go to www myflorida com/dor Transfer the amount on Line 3 to Tentative tax due on reverse side Transfer the amount on Line 3 to Tentative tax due on reverse side Under penalties of perjury I declare that I have been authorized by the above named taxpayer to make this Under penalties of perjury I declare that I have been authorized by the above named taxpayer to make this US DOLLARS CENTS US DOLLARS CENTS When to file File this application on or before the original due date of the taxpayer s When to file File this application on or before the original due date of the taxpayer s Write your numbers as shown and enter one number per box Write your numbers as shown and enter one number per box You must write within the boxes You must write within the boxes