CITY OF BIG RAPIDS
                    APPLICATION FOR EXTENSION

Name __________________________________________________________________________

Address (Number and Street) ________________________________________________________

City, State, Zip ____________________________________________________________________

Social Security # or
Federal I.D.# ____________________________________________________________________

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

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-
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 an Extension
of Time to File a City Income Tax Return must be filed.

CITY INCOME TAX ORDINANCE - Sec. 64 Paragraph 2
Interest and penalty will not be assessed if:
             your return is filed and final tax payment is made by April 30th OR
             Estimated tax payments of 70% or more of the tax shown due for the current year or previous year are paid in full 90
             days prior to your filing due date of April 30th or fiscal year period.

Taxpayer/Authorized Signature                                             Printed Taxpayer/Authorized Signature

Date