1111111111222222222233333333334444444444555555555566666666667777777777888
34567890123456789012345678901234567890123456789012345678901234567890123456789012
4 State of Rhode Island Division of Taxation 4
5 Form RI-4768 5
6 Estate Tax Extension Application 16160499990101 6
7 7
8 APPLICATION FOR 6 MONTH EXTENSION OF TIME TO FILE 8
9 9
Decedent's first name MI Last name Suffix Decedent's social security number
10 10
11 11
Additional Decedent'sXXXXXXXXXXXXXXXXaddress - Legal residence (domicile)X atXXXXXXXXXXXXXXXXXXXtime of deathCity, town or post office XXX 999-99-9999State ZIP code
12 Extension 12
13 Request XXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX XX 99999 13
Date of death Estate tax return due date Executor: If you are out of the country and filing Requested extension date
14 The $50 filing fee for additional time to file, enter the requested 14
15 must accompany 07/08/2016 10/01/2019 extension date in the box on the right 12/01/2019 15
16 this extension. Do Executor/personal rep/admin's first name MI Last name Suffix Executor/personal rep/admin's SSN 16
not remit again
17 when form RI-706 is XXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXX XXX 999-99-9999 17
18 filed. Executor/personal rep/admin's address City, town or post office State ZIP code 18
19 XXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX XX 99999 19
20 Preparer's first name MI Last name Suffix Preparer telephone number 20
21 21
Preparer's firm name, if applicableXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXX XXX (999) 999-9999
22 22
23 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 23
24 Preparer's address City, town or post office State ZIP code 24
25 25
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXMarital status of the decedent at time of death XXXXXXXXXXXXXXXXXXX XX 99999
26 26
27 Married Widow/widower Single Legally separated Divorced 27
28 Payment to Accompany Extension Request 28
29 29
30 1 Estimated gross estate ........................................................................................................................... 1 9999999999999 99 30
31 31
32 2 Amount of Rhode Island estate taxes estimated to be due...................................................................... 2 9999999999999 99 32
33 33
34 3 Amount enclosed with extension application............................................................................................ 3 9999999999999 99 34
35 35
36 Additional Extension Request 36
37 If you are an executor out of the country applying for an extension of time to file in excess of 6 months, check the box above and enter 37
38 the requested extension date on line 3 of the header. Attach a statement explaining in detail why it is impossible or impractical to file 38
39 Form RI-706 by the due date. 39
40 40
41 If filed by other than the executor (check the appropriate box): 41
42 A member in good standing of the bar of the highest court of (specify jurisdiction)____________________________XXXXXXXXXXXXXXXXXXX 42
43 43
44 A certified public accountant duly qualified to practice in (specify jurisdiction) ______________________________XXXXXXXXXXXXXXXXXXX 44
45 45
46 A licensed public accountant in (specify jurisdiction) ______________________________XXXXXXXXXXXXXXXXXXX 46
47 47
48 A person actively enrolled to practice before the Internal Revenue Service. 48
49 49
50 A duly authorized agent holding a power of attorney. (Unless requested, the power of attorney does not need to be submitted. 50
51 51
52 If filed by executor - Under penalties of perjury, I declare that I am an executor of the estate of the above-named decedent and that to the best of my 52
53 knowledge and belief, the statements made herein and attached are true and correct. Otherwise - Under penalties of perjury, I declare that to the best of 53
my knowledge and belief, the statements made herein and attached are true and correct, that I am authorized by an executor to file this application, and
54 that I am filing this extension in the capacity stated above. 54
55 Executor's signature Date Telephone number 55
56 56
57 57
Preparer signature if filed by someone other than executor 10/15/2019 Date (999) PTIN999-9999
58 58
59 10/14/2019 P99999999 59
60 60
61 May the Division of Taxation contact your preparer? YES 61
62 Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908 62
1111111111222222222233333333334444444444555555555566666666667777777777888
34567890123456789012345678901234567890123456789012345678901234567890123456789012
A DEATH CERTIFICATE MUST BE ATTACHED TO FORM RI-4768 WHEN REQUESTING AN EXTENSION.
Revised 10/2021