Rule 12C-1.051
Florida Administrative Code         Florida Department of Revenue - Corporate Income Tax                                                                     F-7004
Effective 01/17                               Florida Tentative Income / Franchise Tax                                                                       R. 01/17
                                    Return and Application for Extension of Time to File Return                                                              TC

You must write within the boxes.    (example) 0 1 23 4 567 8 9 If typing, type through the boxes.                                (example) 0123456789
Write your numbers as shown and enter one number per box.
                                                                                                                             FEIN
Name                                                                                                             Taxable year end:   Type of federal    1065 1120S
Address                                                                                                                              return to be filed
                                                                                                                                           one box only)
City/St                                                                                                    M     M D         D Y   Y       (Mark “X” in 
ZIP                         F-7004                                                                                                                      All other federal 
                                                                                                                                                        returns to be filed

Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this                           US DOLLARS              CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
                                                                                                           Tentative tax due 
Sign here: __________________________________________Date:                                                 (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135

                                              9100 0 20239999 0002005030 9 3999999999 0000 2

Rule 12C-1.051
Florida Administrative Code         Florida Department of Revenue - Corporate Income Tax                                                                     F-7004
Effective 01/17
                                              Florida Tentative Income / Franchise Tax                                                                       R. 01/17
                                    Return and Application for Extension of Time to File Return                                                              TC

You must write within the boxes.    (example) 0 1 23 4 567 8 9 If typing, type through the boxes.                                (example) 0123456789
Write your numbers as shown and enter one number per box.
                                                                                                                             FEIN
Name                                                                                                             Taxable year end:                      1065 1120S
                                                                                                                                     Type of federal 
Address                                                                                                                              return to be filed
                                                                                                                                           (Mark “X” in 
City/St                                                                                                    M     M D         D Y   Y       one box only)
ZIP                         F-7004                                                                                                                      All other federal 
                                                                                                                                                        returns to be filed

Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this                           US DOLLARS              CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
                                                                                                           Tentative tax due 
Sign here: __________________________________________Date:                                                 (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135

                                              9100 0 20239999 0002005030 9 3999999999 0000 2

Rule 12C-1.051
Florida Administrative Code         Florida Department of Revenue - Corporate Income Tax                                                                     F-7004
Effective 01/17                               Florida Tentative Income / Franchise Tax                                                                       R. 01/17
                                    Return and Application for Extension of Time to File Return                                                              TC

You must write within the boxes.    (example) 0 1 23 4 567 8 9 If typing, type through the boxes.                                (example) 0123456789
Write your numbers as shown and enter one number per box.
                                                                                                                             FEIN

Name                                                                                                             Taxable year end:                      1065 1120S
Address                                                                                                                              Type of federal 
                                                                                                                                     return to be filed
                                                                                                                                           (Mark “X” in 
City/St                                                                                                    M     M D         D Y   Y       one box only)
ZIP                         F-7004                                                                                                                      All other federal 
                                                                                                                                                        returns to be filed

Under penalties of perjury, I declare that I have been authorized by the above-named taxpayer to make this                           US DOLLARS              CENTS
application, and that to the best of my knowledge and belief the statements herein are true and correct:
                                                                                                           Tentative tax due 
Sign here: __________________________________________Date:                                                 (See reverse side)
Make checks payable to and mail to: Florida Department of Revenue, 5050 W Tennessee St, Tallahassee FL 32399-0135

                                              9100 0 20239999 0002005030 9 3999999999 0000 2

                                            Information for Filing Florida Form F-7004                                                                   F-7004
When to file — File this application on or before the original due date of the       A.  If applicable, state the reason you need the extension: R. 01/17
taxpayer’s corporate income tax or partnership return. Do not file before the end of    _______________________________________________________
the tax year.                                                                           _______________________________________________________
To file online go to www.floridarevenue.com                                          B.  Type of federal return filed: _________________________________
Penalties —If you are required to pay tax with this application, failure to pay all    Contact person for questions: _______________________________
taxes due will void any extension of time and subject the taxpayer to penalties and    Telephone number: (________)  _____________________________
interest. There is also a penalty for a late-filed return when no tax is due.          Contact person email address: ______________________________
Signature — A person authorized by the taxpayer must sign Florida Form F-7004. 
They must be: an officer or partner of the taxpayer; a person currently enrolled 
to practice before the Internal Revenue Service (IRS); or an attorney or Certified 
Public Accountant qualified to practice before the IRS under Public Law 89-332.        Extension of Time Request                                Florida Income/
The Florida Form F-7004 must be filed – To receive an extension of time to file                                                               Franchise Tax Due
your Florida return, Florida Form F-7004 must be timely filed, even if you have       1. Tentative amount of Florida tax for the taxable year 1.
already filed a federal extension request.  A federal extension by itself does not 
extend the time to file a Florida return.                                             2. LESS: Estimated tax payments for the taxable year    2.
An extension for Florida tax purposes may be granted, even though no federal          3.  Balance due — You must pay 100% of the tax          3.
extension was granted. See Rule 12C-1.0222, F.A.C., for information on the             tentatively determined due with this extension request.
requirements that must be met for your request for an extension of time to be valid.  Transfer the amount on Line 3 to Tentative tax due on reverse side.

                                            Information for Filing Florida Form F-7004                                                                   F-7004
When to file — File this application on or before the original due date of the       A.  If applicable, state the reason you need the extension: R. 01/17
taxpayer’s corporate income tax or partnership return. Do not file before the end of    ______________________________________________________
the tax year.                                                                           ______________________________________________________
To file online go to www.floridarevenue.com                                          B.  Type of federal return filed: ________________________________
Penalties —If you are required to pay tax with this application, failure to pay all    Contact person for questions: ______________________________
taxes due will void any extension of time and subject the taxpayer to penalties and    Telephone number: (________)  ____________________________
interest. There is also a penalty for a late-filed return when no tax is due.          Contact person email address: ______________________________
Signature — A person authorized by the taxpayer must sign Florida Form F-7004. 
They must be: an officer or partner of the taxpayer; a person currently enrolled 
to practice before the Internal Revenue Service (IRS); or an attorney or Certified 
Public Accountant qualified to practice before the IRS under Public Law 89-332.                                                               Florida Income/Fran-
The Florida Form F-7004 must be filed – To receive an extension of time to file        Extension of Time Request                                chise Tax Due
your Florida return, Florida Form F-7004 must be timely filed, even if you have       1. Tentative amount of Florida tax for the taxable year 1.
already filed a federal extension request.  A federal extension by itself does not 
extend the time to file a Florida return.                                             2. LESS: Estimated tax payments for the taxable year    2.
An extension for Florida tax purposes may be granted, even though no federal          3.  Balance due — You must pay 100% of the tax          3.
extension was granted. See Rule 12C-1.0222, F.A.C., for information on the             tentatively determined due with this extension request.
requirements that must be met for your request for an extension of time to be valid.  Transfer the amount on Line 3 to Tentative tax due on reverse side.

                                                                                                                                                         F-7004
                                            Information for Filing Florida Form F-7004                                                           R. 01/17
When to file — File this application on or before the original due date of the       A.  If applicable, state the reason you need the extension: 
taxpayer’s corporate income tax or partnership return. Do not file before the end of    ______________________________________________________
the tax year.                                                                           ______________________________________________________
To file online go to www.floridarevenue.com                                          B.  Type of federal return filed: ________________________________
Penalties —If you are required to pay tax with this application, failure to pay all    Contact person for questions: ______________________________
taxes due will void any extension of time and subject the taxpayer to penalties and    Telephone number: (________)  ____________________________
interest. There is also a penalty for a late-filed return when no tax is due.          Contact person email address: ______________________________
Signature — A person authorized by the taxpayer must sign Florida Form F-7004. 
They must be: an officer or partner of the taxpayer; a person currently enrolled 
to practice before the Internal Revenue Service (IRS); or an attorney or Certified 
Public Accountant qualified to practice before the IRS under Public Law 89-332.                                                                 Florida Income/
The Florida Form F-7004 must be filed – To receive an extension of time to file        Extension of Time Request                              Franchise Tax Due
your Florida return, Florida Form F-7004 must be timely filed, even if you have       1. Tentative amount of Florida tax for the taxable year 1.
already filed a federal extension request.  A federal extension by itself does not 
extend the time to file a Florida return.                                             2. LESS: Estimated tax payments for the taxable year    2.
An extension for Florida tax purposes may be granted, even though no federal          3.  Balance due — You must pay 100% of the tax          3.
extension was granted. See Rule 12C-1.0222, F.A.C., for information on the             tentatively determined due with this extension request.
requirements that must be met for your request for an extension of time to be valid.  Transfer the amount on Line 3 to Tentative tax due on reverse side.