Form F-7004 Fillable Tentative Income/Franchise Tax Return and Application for Extension of Time to File Return R.01/15
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Contact person email address: Contact person email address: Contact person for questions: Contact person for questions: Telephone number: ( ) Telephone number: ( ) (example) (example) (example) (Mark X in (Mark X in (See reverse side) (See reverse side) 0123456789 0123456789 0123456789 1 Tentative amount of Florida tax for the taxable year 1 Tentative amount of Florida tax for the taxable year 2 LESS: Estimated tax payments for the taxable year 2 LESS: Estimated tax payments for the taxable year 3 Balance due You must pay 100% of the tax 3 Balance due You must pay 100% of the tax 9100 0 20159999 0002005030 4 3999999999 0000 2 9100 0 20159999 0002005030 4 3999999999 0000 2 A If applicable state the reason you need the extension: A If applicable state the reason you need the extension: Address Address already filed a federal extension request A federal extension by itself does not already filed a federal extension request A federal extension by itself does not 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 and interest There is also a penalty for a late filed return when no tax is due and interest There is also a penalty for a late filed return when no tax is due application and that to the best of my knowledge and belief the statements herein are true and correct: application and that to the best of my knowledge and belief the statements herein are true and correct: B Type of federal return filed: B Type of federal return filed: Check here if you transmitted Check here if you transmitted City/St City/St Corporation Corporation Effective 01/15 Effective 01/15 extend the time to file a Florida return extend the time to file a Florida return Extension of Time Request Extension of Time Request 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 F 7004 F 7004 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 Income/ Florida Income/ Florida Tentative Income / Franchise Tax Florida Tentative Income / Franchise Tax Franchise Tax Due Franchise Tax Due funds electronically funds electronically If typing type through the boxes If typing type through the boxes Information for Filing Florida Form F 7004 Information for Filing Florida Form F 7004 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 of the tax year of the tax year one box only) one box only) Partnership Partnership Penalties If you are required to pay tax with this application failure to pay all Penalties If you are required to pay tax with this application failure to pay all Public Accountant qualified to practice before the IRS under Public Law 89 332 Public Accountant qualified to practice before the IRS under Public Law 89 332 R 01/15 R 01/15 R 01/15 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 Taxable year end: Taxable year end: taxes due will void any extension of time and subject the taxpayer to penalties taxes due will void any extension of time and subject the taxpayer to penalties taxpayer s corporate income tax or partnership return Do not file before the end taxpayer s corporate income tax or partnership return Do not file before the end 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 The Florida Form F 7004 must be filed To receive an extension of time to file They must be: an officer or partner of the taxpayer; a person currently enrolled They must be: an officer or partner of the taxpayer; a person currently enrolled To file online go to www myflorida com/dor To file online go to www myflorida com/dor to practice before the Internal Revenue Service (IRS); or an attorney or Certified to practice before the Internal Revenue Service (IRS); or an attorney or Certified 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 When to file File this application on or before the original due date of the 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 your Florida return Florida Form F 7004 must be timely filed even if you have your Florida return Florida Form F 7004 must be timely filed even if you have