5713 International Boycott Report

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

3

TLS, have you
transmitted all R
text files for this
cycle update?

I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8878, PAGE 1 OF 2
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)

Date

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form

©

Taxpayer’s name

©

Signature

O.K. to print
Revised proofs
requested

OMB No. 1545-0074

f
o
s
a
6
t
0
f
0
a
2
r
/
D /26
9
0

2006

Do not send to the IRS. This is not an application for an extension of time to file.
© Keep this form for your records. See instructions.

Declaration Control Number (DCN)

Social security number

Spouse’s name

Part I

Date

IRS e-file Signature Authorization for
Form 4868 or Form 2350

8878

Department of the Treasury
Internal Revenue Service

Action

Spouse’s social security number

Information from Extension Form—Tax Year Ending December 31, 2006 (Whole Dollars Only)

Check the box and complete the line(s) for the form you authorize your ERO to sign and file. Check only one box.
Form 4868, Application for Automatic Extension of Time To File U.S. Individual Income Tax Return
1
Amount you are paying from line 7 of Form 4868
Form 2350, Application for Extension of Time To File U.S. Income Tax Return
I request an extension of time until this date as shown on line 1 of Form 2350
2a
Amount you are paying from line 5 of Form 2350
2b

1
2
a
b

Part II

Taxpayer Declaration and Signature Authorization

Under penalties of perjury, I declare that I have examined a copy of my electronic application for extension of time to file for the tax year ending December
31, 2006, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the information listed above is the information
from my electronic application for extension of time to file. I consent to allow my intermediate service provider, transmitter, or electronic return originator
(ERO) to send this form to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission and (b) the
reason for any delay in processing the form. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds
withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my Federal taxes, and the financial
institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate
the authorization. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the
payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential
information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN)
below is my signature for my electronic application for extension of time to file and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only
I authorize

to enter or generate my PIN

as
do not enter all zeros

ERO firm name

my signature for my electronic application for extension of time to file for the tax year ending December 31, 2006.
I will enter my PIN as my signature for my electronic application for extension of time to file for the tax year ending
December 31, 2006. Check this box only if you are entering your own PIN and your extension form is filed using the
Practitioner PIN method. The ERO must complete Part III below.
Your signature

©

Date

©

Spouse’s PIN: check one box only
I authorize

to enter or generate my PIN
ERO firm name

as
do not enter all zeros

my signature for my electronic application for extension of time to file for the tax year ending December 31, 2006.
I will enter my PIN as my signature for my electronic application for extension of time to file for the tax year ending
December 31, 2006. Check this box only if you are entering your own PIN and your extension form is filed using the
Practitioner PIN method. The ERO must complete Part III below.
Spouse’s signature

©

Date

©

Practitioner PIN Method for Form 4868 Only—continue below
Part III

Certification and Authentication—Practitioner PIN Method for Form 4868 Only

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature to authorize submission of the electronic Form 4868 and electronic funds withdrawal
for the taxpayer(s) indicated above. I confirm that I am submitting Form 4868 in accordance with the requirements of the Practitioner PIN method and
Publication 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO’s signature

©

Date

©

ERO Must Retain This Form — See Instructions
Do Not Submit This Form to the IRS Unless Requested To Do So
For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Cat. No. 32777M

Form

8878

(2006)