Rev. 10/99
                                                           Form M-4768A                                                                         Massachusetts
                                Application for Extension of Time to Pay                                                                        Department of
                                                                                                                                                Revenue
                                                Massachusetts Estate Tax

File in duplicate with payment.

                                                                                     Name of decedent
                                                                                     ¨
Mail to:                                                                             Probate court                        Date of death
Name of       ¨                                                                                                           ¨
applicant                                                                            Docket number                        Decedent’s Social Security number
                                                                                                                          ¨
Street address
                                                                                     Residence (domicile) at time of death

City/Town,
State, Zip code

Part 1. Extension of Time to Pay
Application is hereby made to the Commissioner of Revenue for the following extension of time to pay the Massachusetts Estate Tax on the estate
named above.
Extension of time to payBased solely on reasonable causeBased solely on undue hardship.                                   Mass. estate tax return due date
  Based on undue hardship with alternate request for reasonable cause if undue hardship is denied.
Reason extension is applied for:                                                                                          Extension date requested
                                                                                                                          ¨

Part 2. Payment to Accompany Extension Request
1. Estimated amount of Massachusetts estate tax due. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ¨     $
2. Less: Advance and/or estimated payments made (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       $
3. Prior extension payments (attach copy of Form M-4768 and/or Form M-4768A). . . . . . . . . . . . . . . . . . . . . . .                      $
4. Balance due with this application. Subtract the total of line 2 and line 3 from line 1            . . . . . . . . . . . . . . . . . . . . . $

Part 3. Certification
Name of executor, administrator, or person in possession of decedent’s propertyName of attorney for estate

Street address                                                                 Street address

City/Town                                       State   Zip                    City/Town                                  State                 Zip

I declare under the penalties of perjury that this application has been examined by me and to the best of my knowledge and belief it is true
and correct.
Signature                                                                      Title                                      Date

Signature                                                                      Title                                      Date

Part 4. Notice to Applicant.                            To be completed by Estate Tax Bureau.
The application for extension of time to pay is:ApprovedNot approved           Other.

Commissioner of Revenue                                                                                                   Date
By
Make check payable to the Commonwealth of Massachusetts. Send to: Massachusetts Department of Revenue, Estate Tax Bureau, PO Box 7023,
Boston, MA 02204. Attach a copy of this application to the Estate Tax Return when filed.
Form code: 653

                                            Form M-4768A Instructions

Who May File                                                  must be paid before the expiration of such period, plus the
This application may be filed by an executor or administra-   interest thereon from the original due date of the return, to
tor, or if there is no executor or administrator appointed,   the date of payment.
qualified and acting within the Commonwealth, then by any     Note: An extension of time to pay does not extend the due
person in actual or constructive possession of any property   date for filing of the return. Form M-4768, Application for
of the decedent.                                              Extension of Time to File Massachusetts Estate Tax Return,
                                                              may be filed, if necessary.
Due Date of Massachusetts Estate Tax
Return, Form M-706                                            When to File
Form M-706, Estate Tax Return, is due within nine months      File this application sufficiently early to permit the Mass-
after the date of decedent’s death (with respect to those     achusetts Estate Tax Bureau to consider the application
estates of decedents dying on or after January 1, 1976). The  and reply before the due date of the return. An extension of
tax is due at the time of filing the return.                  time to pay shall only be granted if application is made prior
                                                              to the due date of the return.
Specific Instructions
An extension of time to pay must be for a reasonable period,  How and Where to File
not to exceed six months. If, however, the Commissioner       Complete this form in duplicate and file with the Massachu-
finds that payment on the due date would result in undue      setts Department of Revenue, Estate Tax Bureau, PO Box
hardship, he may extend the payment date for a period not     7023, Boston, MA 02204.
in excess of three years from the due date of the tax.
                                                              Interest
An application based on reasonable cause must establish
why it is impossible or impracticable for the executor to pay Any unpaid portion of the tax finally determined to be due
the full amount of the estate tax on or before the due date.  will bear interest from the original due date of the return to
                                                              the date of payment.
An application based on undue hardship must establish
such undue hardship that would result to the estate if the    Penalties
application is denied.
                                                              If the Massachusetts Estate Tax is not timely paid, a penalty
This application will be granted only for the amount of the   shall be imposed at the rate of ¹⁄�% per month, or fraction
cash shortage. The amount of the estate tax, the cash         thereof, to a maximum of 25% of the unpaid balance.
shortage and the balance due should be indicated. Make a
check payable to the Commonwealth of Massachusetts for        If the Massachusetts Estate Tax Return is not timely filed,
the balance due. Enter the decedent’s Social Security num-    a penalty shall be imposed at the rate of 1% per month,
ber on the check.                                             or fraction thereof, to a maximum of 25% of the unpaid
                                                              balance.
The Massachusetts Estate Tax Bureau will complete the
form and return a copy to the applicant. If the application isBond
approved, attach a copy to the estate tax return filed. The
                                                              If an extension of time to pay is granted, the executor may
part of the estate tax for which the extension is granted
                                                              be required to furnish a bond.