GR-4868
                                        Application for Automatic Extension of Time
CITY OF
                                                    To File Grayling Income Tax Return                                                                                 TAX YEAR
GRAYLING

        Your first name and initial (If joint, also give spouse’s name and initial)                              Last Name                                   Your social security number
Please
TypePresent home address                                                        Mailing AddressSpouse’s social security number
or
        City, town or post office, state, and ZIP code                                                                                                           Employer ID number
Print

                                                                       CORPORATION PARTNERSHIP ESTATE
EXTENSION IS
                                    INDIVIDUAL
REQUIRED FOR:
                                                                           CALENDAR YEAR FILERFISCAL YEAR FILLER

DIRECTIONS:Prepare this form in duplicate. File the original with the Grayling Income Tax Dept.  on or before the due date for 
                        filling your return (if you wish to have an approved  copy, you must  enclose a stamped pre-addressed envelope in
                        which it will be returned.) Attach the duplicate to your Grayling Income Tax Return when filed.

INDIVIDUALWhen form GR-4868 is filed timely, an automatic extension will be granted for INDIVIDUAL RETURNS until 
   RETURNS{August 30 of the year the return is due. The tentative tax must be paid  with this application for extension.

                        When an extension of greater than four months is requested, the tax tentatively determined to be due must be paid by 
                        the last day of the fourth month. The Uniform City Income Tax Ordinance limits the extension of time for filing annual
                        returns to SIX MONTHS from the due date.
CORPORATIONS
PARTNERSHIPS
     ESTATESA ______________________month extension of time for filing until__________________,________ is hereby
                                                                                                                                                                   YEAR
                        requested in which to file the Grayling Tax Return as indicated above for the calendar year_____________________
             {of the fiscal year beginning __________________,________  and ending __________________,________ . 
                                                                                                                 YEAR                                                      YEAR

TENTATTIVEAX COMPUTATION:
     1. Tentative City of Grayling Income Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                . . . . .$_____________
     2. Less:
           a. City Income Tax Withheld  . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_____________
           b. Estimated Tax Paid to Grayling  . . . . . . . . . . . . . . . . . . . . . . . .$_____________
           c. Other Credits  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_____________
           d. Total Credits (add line a,b and c)  . . . . . . . . . . . . . . . . . . . . . . .$_____________

3. BALANCE DUE (line 1 less line 2d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                             . . . . . . . . .$_____________
                                                                                                                                                           ANY BALANCE DUE MUST BE PAID WITH THIS APPLICATION
SIGNA AND TURE  VERIFICATION:
Under penalties of perjury, I declare that I have examined this form,  including accompanying schedules and statements and to t                                                         he
best of my knowledge and belief, it is true, correct, and complete; if prepared by someone other than the taxpayer, I am authorized
to prepare this form.

Signature of taxpayer:___________________________________________________ Date:_____________________

Signature of spouse:____________________________________________________ Date:______________________
                                                         (If filing jointly, BOTH MUST sign)
Signature of preparer other than the taxpayer:_____________________________________ Date:_________________
   MAIL TO: Grayling Income Dept. P.O. Box 549, Grayling, MI 49738  (make checks payable to: CITY TREASURER)

Your request for an Extension is:APPROVED                                                                                                   DENIED

By: _____________________________________________________________________
             Income Tax Administrator                                                                                                              Date