Form 7004N Fillable Application for Automatic Extension of Time (1/2015)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

1 Tentative income tax liability for taxable period before any applicable credits 1 10 Total prior payments and credits (total of lines 7 through 9) 10 11 Tentative tax payment (line 6 minus line 10) 11 2 Premium tax credit 2 3 Community Development Assistance Act credit 3 4 Form 3800N nonrefundable credits 4 5 Total nonrefundable credits (total of lines 2 through 4) 5 6 Subtract line 5 from line 1 (if the line 5 amount is more than the line 1 amount enter 0 ) 6 7 Form 3800N refundable credits 7 8 Estimated tax payments 8 9 Other payments or credits including any Beginning Farmer credit 9 Attach a copy of the Federal Form 7004 filed with the Automatic seven month filing extension from the Extension in addition to the federal extension up to a Check all appropriate boxes if filing Nebraska Forms 1120N or 1120 SN Check one of the boxes below if filing Federal Forms 1041 (bankruptcy estate only) 1041 QFT 1041 N or 1065 B Check one of the boxes below if filing Federal Forms 1041 (except bankruptcy estates) or 1065 Check this box if your payment is being made electronically City State Zip Code Federal ID Number Nebraska ID Number Entities filing a fiduciary or partnership return need not complete lines 1 through 10 below A fiduciary or partnership must complete line 11 If Yes enter the original due date of the cooperative s federal return Internal Revenue Service Legal Name Name Doing Business As (dba) Nebraska Fiduciary Income Tax Return Form 1041N Nebraska Return of Partnership Income Form 1065N original due date maximum of seven months from the original due date Street or Other Mailing Address Under penalties of perjury I declare that I have been authorized to make this application and that to the best of my knowledge and belief the 7004N 8 021 1968 Rev 12 2014 ACH Credit You (or your bank) create an electronic file in the appropriate ACH file format It is submitted to the Amount of Payment Payment of the amount shown on line 11 must be remitted with this form and will appear on your credit card statement separately from the tax payment At the end of your transaction you will Application for Automatic Extension of Time Authorized Signature Date Email Address authorizes any other person to sign this application there must be a power of attorney on file with the Department Automatic 5 Month Extension Automatic 6 Month Extension Automatic 7 Month Extension be given a confirmation number Keep this number for your records [If you are making your credit card payment by Call 800 232 0057 enter your payment and bank account information and choose a date (up to a year in advance) to Check or Money Order If you are not using one of the electronic payment options described above include a check or complete this application When your Nebraska income tax return is filed you must attach a copy of the Federal Form 7004 corporate income tax return file Form 7004N on or before the date the federal extension expires Attach a copy of the Federal corporate return Corporate Unitary Group Members of a unitary group filing a single return using the combined income approach should corporation included in the combined return must be listed on Form 7004N Corporations When a federal extension of time has been granted and additional time is necessary to file a Nebraska Credit Card (Corporations only) Secure credit card payments can be initiated through Official Payments at Electronic Payment Options electronically For mandate purposes all of the electronic payment options listed below satisfy the mandate requirement All entities are encouraged to make their payments electronically Extension of Time Form 7004N The Form 7004N must be filed even if a tentative income tax payment is made electronically Federal Federal Reserve and instructs your bank to credit the state s bank account filed with the IRS or a copy of the approved federal extension If a federal extension of time has been granted the filing date for Forms 1120N 1120 SN 1041N and 1065N is automatically extended for the same period Form 7004 filed with the IRS or a copy of the approved federal extension A maximum of a seven month extension beyond Form 7004N on or before the date that a federal extension expires have your account debited You will receive a confirmation number at the end of your call ID NUMBERS If the corporation is a member of a unitary group of corporations filing a combined return complete the following section If you have filed for a federal extension and are not making a tentative income tax payment to Nebraska you do not need to Instructions Is the corporation a cooperative? YES NO Is the corporation organized as an exempt organization? YES NO Mail this application and remit payment (electronically if required) to: making a tentative tax payment and/or wanting more time to file a Nebraska tax return must file a Nebraska Application for Mandates of Electronic Payment Some entities are required to make their payments (tax penalty and interest) money order payable to the Nebraska Department of Revenue Checks written to the Department may be presented for Name and Address of Each Member of the Unitary Group Nebraska Nebraska 68509 4818 Nebraska Department of Revenue PO Box 94818 Lincoln NE 68509 4818 Nebraska e pay Nebraska e pay is the Department s web based electronic payment system You enter your Nebraska Tele pay Nebraska Tele pay is the Department s phone based electronic payment system of time to file a return officialpayments com; via phone at 800 2PAY TAX; or by downloading the OPAY app from your smart phone s app only request one extension for the entire group The name address Federal ID number and Nebraska ID number of each Partnerships Estates and Trusts Nebraska will only allow extensions of time up to the maximum number of months payment and bank account information and choose a date (up to a year in advance) to have your account debited You payment electronically phone you will need to provide the Nebraska Jurisdiction Code which is 3700 ] provided by the IRS No additional Nebraska extension will be granted revenue nebraska gov 800 742 7474 (NE and IA) 402 471 5729 sent to the address entered on Form 7004N No notice will be sent with respect to approved applications for an extension Signatures This application must be signed by a corporate officer fiduciary partner member a person currently enrolled statements made above are correct and complete store Eligible credit cards include American Express Discover MasterCard and VISA A convenience fee (2 49% of Supersedes 8 021 1968 Rev 12 2013 Taxable year beginning and ending Taxpayer Notification The Department will notify the applicant if this request for extension is denied The notice will be Tentative Tax Payment Calculation Termination of Extension The Department may at any time terminate a C corporation s extension of time by mailing the original due date of the corporate income tax return is allowed for Nebraska the tax payment $1 minimum) is charged to the card you use This fee is paid to the credit card vendor not the state the taxpayer a notice of this termination allowing ten days from the date of the termination notice to file the Nebraska Title Daytime Phone Number to File Nebraska Corporation Fiduciary or Partnership Return to practice before the IRS or an attorney or certified public accountant qualified to practice before the IRS If the taxpayer When to File Form 7004N must be filed on or before the due date of the original return Corporations may also file Where to File Mail Form 7004N with remittance to the Nebraska Department of Revenue PO Box 94818 Lincoln Who May File A corporation (C corporation and S corporation) fiduciary partnership or limited liability company will receive an email confirmation for each payment scheduled