APPLICATION FOR EXTENSION OF TIME TO FILE CITY OF BIG 

                         RAPIDS INCOME TAX RETURN 

An extension is not a request for additional time to pay tax due. The filing of Federal Forms 4868 
and 7004, Application for Automatic Extension of Time to File U.S. Income Tax return, with the Internal 
Revenue Service, does not grant an extension of time to file a city income tax return. An Application for 
Extension of Time to File a City Income Tax return must still be filed. 

Name 

Address (Number and Street) 

City, State, Zip 

Social Security Number/FEIN 

Check type of return to be filed and attach Federal Extension: 

                           BR 1040 Individual    Attach Federal Form 4868 
                           BR 1120 Corporation   Attach Federal Form 7004 
                           BR 1065 Partnership   Attach Federal Form 7004 

The Uniform City Income Tax Ordinance limits the extension of time for filing annual returns to SIX 
months from the original due date. 

Taxable Year of                                or Fiscal Year of                to                         . 

Extension requested until                                               , to file the Big Rapids 
Income Tax Return (Not to exceed six months). 

1. Your Tax Liability $
2. Your Record of Credits
   (a) Overpayments credited from prior year   $ 
   (b) Estimated tax payments for the year     $ 
   (c) Withholding for the current year        $ 
   (d) Tentative tax paid with application     $ 
                 TOTAL CREDITS                 $ 
                 BALANCE                       $  0.00 

Interest and penalty will not be assessed if the tax paid through withholding, timely quarterly estimated tax payments and/or 
credits is at least 70% of the total tax due with your Big Rapids Income Tax Return, and if the remaining balance is paid with 
this extension request. Failure to pay the tentative tax balance due invalidates the extension request. 

       Taxpayer/Authorized Signature             Printed Taxpayer/Authorized Signature                   

       Date 

                       Make Check or Money Order Payable to: CITY OF BIG RAPIDS 
       Mail to: City of Big Rapids, Income Tax Department, 226 N Michigan Ave, Big Rapids, MI 49307 
                                                                                                        Revised 01/17/2019