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APPLICATION FOR EXTENSION OF TIME
TO FILE INDIVIDUAL, GENERAL PARTNERSHIP AND
FIDUCIARY INCOME TAX RETURNS FOR KENTUCKY
40A102 (11-12)Commonwealth o Kentucky
DEPARTMENT OF REVENUE 2012
Last name First name (joint or combined return, give both names and initials) Your Social Security number
Mailing address (Number and Street including Apartment Number or P.O. Box) Spouses Social Security numbe
City, town or post ofce State ZIP code
Enter payment amount here ............... $
SECTION I(Please print or type name and address in block below.)
Check type o return:
Individual (740 or 740-NP) General Partnership (765-GP)
Fiduciary (741)
Soc. Sec. No. or Employer ID No.
A six-month extension is requested or fling the income tax return o the above-named taxpayer(s) or the taxable yea
ended .
REASON FOR REQUEST (A reason must be given beore any request can be considered. Inability to pay tax liability is not a val
reason.)
Signature o taxpayer Date Preparer other than taxpayer Date
Mail to: Kentucky Department o Revenue, P.O. Box 1190, Frankort, KY 40602-1190
DENIED: Late (postmarked after return due date) Other:
Use this orm i you (1) are requesting a Kentucky extension o time fle (complete Section I); (2) are requesting a Kentucky extension adesire to make a payment prior to the due date (complete Sections I anII); or (3) have a ederal extension and desire only to make a Kentucpayment prior to the due date (complete and submit Section II only
You will be notifed only i the application or extension is denied. avoid the late fling penalty, a copy o this orm must be attached your return when fled. Keep a copy or yoursel.
COMPLETE ONLY IF NOT FILING FEDERAL EXTENSION
SEE INSTRUCTIONS FOR PAYMENT REQUIREMENTS
INSTRUCTIONS:Taxpayers who request a ederal extension are notrequired to fle a separate Kentucky extension. The requirements maybe met by attaching ederal Form 4868 (automatic extension) to theKentucky return.
Interest at the annual rate o 6 percent applies to any income tax paidater the original due date o the return. I the amount o tax paid by theoriginal due date is less than 75 percent o the tax due, a late paymentpenalty may be assessed (minimum penalty is $10). Interest and latepayment penalty charges can be avoided by remitting payment with theExtension Payment Voucher below by the due date.
201240A102 (11-12)
SECTION IIKENTUCKY
EXTENSION PAYMENT VOUCHE
Make check payable to: Kentucky State Treasurer
Mail to: Kentucky Department o Revenue
P.O. Box 1190
Frankort, KY 40602-1190
*1200020028*
*1200020028*
To avoid the late fling penalty, a copy o this orm must be attached to your return when fled. Keep a copy or yoursel.
COMPLETE ONLY IF MAKING PAYMENT FOR INDIVIDUAL OR FIDUCIARY INCOME TAX