20                           City of Highland Park                                                               20

                             APPLICATION FOR EXTENSION OF TIME
                                 TO FILE INCOME TAX RETURN

Prepare this form in duplicate. File the original with the City’s Income Tax Department on or before the due date for
ling a return. Attach the duplicate to your city income tax return.

NAME                                                                                               TAXABLE PERIOD
                                                            Calendar Year______________________________________________
                                                            Fiscal Year Ending__________________________________________

ADDRESS (STREET NUMBER AND NAME)                                                                   TYPE OF RETURN

                                                             Corporation                            Individual
                                                               Partnership                          Resident
                                                              Estate or Trust                       Non-Resident
CITY, STATE & ZIP CODE
                                                              Employer Identication Number or
                                                                Social Security Number
                                                             _________________________

Reason for extension request:

The City Income Tax Ordinance limits the extension of time for ling annual returns to SIX months from the original due date.
A __________ month extension of time is hereby requested in which to le the income tax return of the above named Taxpayer. The
extended due date of this return is the last day of ____________________, 20

                                             TENTATIVE TAX RETURN
        THE TENTATIVE TAX BALANCE DUE MUST BE PAID WITH THIS EXTENSION.
1.   Tentative Tax (Estimate total tax liability) . . . . . . . . . . . . . . . . . . . . . . .    $______________________
2. Less:
     a. Estimated income tax payment . . . . . . . . . . . . . . . . . . . . . . .                 $______________________
     b. Other credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   $______________________
3.   BALANCE DUE (Line 1 less lines 2a 2b) . . . . . . . . . . . . . . . . . . . . . . .           $______________________
     (Include payment of this amount with extension)
     The extension is automatically granted upon payment of the tentative tax balance due. Failure to pay tentative
     tax if due) could result in penalty for failure to pay.

 ____________________________________________________                                              __________________________
     Signature of taxpayer, ofcer or agent                                                        Date

                                            MAIL TO:  City of Highland Park
                                             Income Tax Department
                                             P.O. Box 239
                                             Eaton Rapids, Mi 48827
                                             

                              INSTRUCTIONS FOR

   APPLICATION FOR EXTENSION OF TIME

   TO FILE CITY OF HIGHLAND PARK

                         INCOME TAX RETURN

WHO MAY REQUEST AN EXTENSION
A taxpayer may request an extension of time to file an individual income tax return. An extension is
a request for additional time to file a tax return. Extensions of time to file are allowed for resident or
nonresident individuals filing form HP-1040, individual income tax return.

An extension is not a request for additional time to pay tax due.

The filing of federal Form 4868, Application for Automatic Extension of Time to File U.S. Individual
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 of Highland Park In-
come Tax Return must be filed.

PERSONS OUTSIDE THE UNITED STATES
Where the federal internal revenue code grants an automatic two-month extension to persons liv-
ing outside the United States, an automatic extension to the same date will be granted. If more
time is needed than this automatic extension allows, an Application for an Extension of Time to File
City of Highland Park Income Tax Return must be filed.

EXTENSION AUTOMATICALLY GRANTED
Upon filing an Application for Extension of Time to File a City of Highland Park Income Tax Return,
the City of Highland Park’s Income Tax Department will automatically grant an extension for up to
six months provided that:

1. The extension request is filed by the due date of the return;
2. The tentative tax return section of the application is competed;
3. Payment of the tentative tax balance due (if owed) is made; and
4. All filing and payment requirements of the city of Highland Park 
   Income Tax Ordinance are satisfied.

An extension is not necessary where no tax will be due when the return is filed. Extensions filed
without payment of the tentative tax due will not be accepted.

PREPARING THE APPLICATION FOR EXTENSION
Prepare the Application for Extension in duplicate. File the original with the City of Highland Park’s
Income Tax Department. When the Application for Extension is timely filed and the tax payment re-
quirements are met, the extension is automatically granted. A copy of the Application for Extension
is to be attached to the City of Highland Park’s Income Tax Return at the time of filing the return.