F-4868                                                                   FLINT                                                      2022 RET REX 
                                             APPLICATION FOR AUTOMATIC EXTENSION OF TIME 
                                                        TO FILE AN INDIVIDUAL INCOME TAX RETURN 

Taxpayer Name: 
Social Security No: 
File on or Before:                        4/30/2023, due date of 2022 return 
Payment:                                 I$                                    I 

Payment Method:                          • Make payment by check or money order payable to "City of Flint." DO NOT SEND CASH.
                                         • Write your Soc. Sec. No., daytime phone number and "2022 F-4868" on check or money
                                          order.
                                         • To pay by credit card or direct debit, see income tax website of the City of Flint.
Address for Payment: 
                                          City of Flint - Income Tax Department
                                          PO Box 529
                                          Eaton Rapids, Ml  48827-0529

Instructions:                            • An extension to file does not extend the due date to pay tax. Tax paid late will be assessed late fees.
                                         • Line 1: Enter the total tax liability you expect to report on your 2022 Form F-1040, page 1, line 23.
                                         • Line 2: Enter the total payments that you expect to report on your 2022 Form F-1040, page 2, line 4, not 
                                          including the extension payment reported on line 3 of this form.
                                         • Filing date: The income tax ordinance limits an extension to SIX months from the original due date.

Related Information:  • Federal extension: Filing a federal extension (Form 4868) with the Internal Revenue Service does not 
                                          grant an extension of time to file a Flint income tax return. 
                                         • Persons living outside the United States: Where the Internal Revenue Code grants an automatic two­
                                          month extension to persons living outside the U.S., an automatic two-month extension will be granted.

Payment:                                 • An extension is automatically granted upon payment of the balance due (line 3); failure to pay the
                                          balance due invalidates the extension request; an extension filed without a payment will not be accepted.
                                         • Interest and penalty will be assessed on taxes paid late even if an extension of time to file is granted.
                                         • Penalty may be waived by the Income Tax Administrator if the tax paid by the original due date is not
                                         understated by more than 5% of tax or the taxpayer can show that the failure to pay on time was due to
                                          reasonable cause.

Taxpayer Records:                         Amount Paid:                         Check Number:                            Date Mailed:
                                                                                                                                    Revised: 12/27/2016 
      KEEP TOP PORTION FOR YOUR RECORDS.  SEND BOTTOM PORTION WITH YOUR PAYMENT 
                                                                       V DETACH HERE  V 
F-4868                                                                   FLINT                                                      2022 RET REX 
         APPLICATION FOR AUTOMATIC EXTENSION OF TIME TO FILE AN INDIVIDUAL INCOME TAX RETURN 
                                                                       Mail  To:  City of Flint - Income Tax Department 
                                                                       PO Box 529 
NACTP#                                                                 Eaton Rapids, Ml  48827-0529 
       I                  I 
EFIN#                                                                                                                               Revised: 12/27/2016 
       I                                   I 
Taxpaye�s first name, initial, last name                               Taxpayer's SSN 

If joint return spouse"s first name. initial, last name                If joint payment, spouse's SSN 

Present home address (Number and street)                  Apt. no.     Payment voucher 2D barcode 

Address line 2 (P.O. Box address for mailing use only) 

City, town or post office                               tate  Zip code 
                                             r          I              1. Estimate of total tax liability for 2022                                  .00 
Foreign country name, province/county, postal code                     2. Total 2022 payments and credits                                           .00 
                                                                       3. Balance due (Line 1 less line 2)                                          .00