Form 1127 Application for Extension of Time for Payment of Tax

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1127, PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 203 mm (8") x 559 mm (22") FOLD TO: 203 mm (8") x 279 mm (11")
PERFORATE: ON FOLD
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1127

Action

Date

Signature

O.K. to print
Revised proofs
requested

Application for Extension of Time for Payment of Tax

OMB No. XXXX-XXXX

(Rev. January 2009)
Department of the Treasury
Internal Revenue Service

©

For use by

Before you begin: See the chart on page 4 to see if you should use this form.
Name shown on return (if a joint return, enter spouse’s name and social security number below)

Social Security Number or Employer Identification Number

Spouse’s name

Spouse’s Social Security Number

Address (number, street, and room or suite no.)

City, town, or post office, state, and ZIP code. If you have a foreign address, see the instructions.

Part I

Request for extension

I request an extension from
,
$
. This request is for calendar year

Part II

, to
or fiscal year ending

,

, to pay tax of
,
.

Reason for extension

Undue hardship. Enter below a detailed explanation outlining how denial of this request will result in an undue hardship. (If
more space is required, please attach a seperate sheet.)

Inability to borrow. I cannot borrow to pay the tax because:

Supporting documentation. To support my request, I am attaching (1) a statement of my assets and liabilities at the end of
last month (showing book and market values of assets and whether securities are listed or unlisted), and (2) an itemized list of
my income and expenses for each of the 3 months prior to the due date of the tax.

Part III Security
I propose to secure this liability as follows:

Signature and Verification
Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules and statements, and to the best of
my knowledge and belief, it is true, correct, and complete; and, if prepared by someone other than the taxpayer, that I am authorized to prepare this
form.
Signature of taxpayer ©

Date ©

Signature of spouse ©

Date ©

Signature of preparer
other than taxpayer ©

Date ©

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 17238O

Form

1127

(Rev. 1-2009)

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1127, PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 203 mm (8") x 559 mm (22") FOLD TO: 203 mm (8") x 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

1127
Form 1041 (Rev. 01-2009)

Page

2

General Instructions

Specific Instructions

Section references are to the Internal Revenue Code.

Name, Address, and Identification Number

Purpose of Form

Individuals. Enter your name, address, and social security
number (SSN) or individual taxpayer identification number
(ITIN). If you are filing a joint return, enter your spouse’s name
and SSN/ITIN on the line below. Enter your and your spouse’s
name in the same order they will appear on your return.

Use Form 1127 to request an extension of time to pay income
tax or an income tax deficiency under section 6161.

Who Should File
You should file Form 1127 if:
1. You will have a tax liability that you cannot pay with your
return without causing undue hardship, or
2. You have been notified of a tax deficiency you are unable to
pay without causing undue hardship.
Undue hardship. “Undue hardship” means more than
inconvenience. You must show you will have a substantial
financial loss (such as selling property at a sacrifice price) if
you pay your tax on the date it is due. For more information,
see the instructions for Part II later.
Note. If you need an extension to pay estate tax, file Form
4768, Application for Extension of Time To File a Return
and/or Pay U.S. Estate (and Generation Skipping Transfer)
Taxes.

When To File
Form 1127, and its supporting documents, should be filed as
soon as you are aware of a tax liability or a tax deficiency you
cannot pay without causing undue hardship.
If you are filing Form 1127 based on a tax due on an
upcoming return, Form 1127 must be received on or before
the due date of that return, not including extensions.

Where To File
File Form 1127 with the Internal Revenue Service (Attn:
Advisory Group Manager), for the area where you maintain
your legal residence or principal place of business. See
Publication 4235, Technical Services (Advisory) Group
Addresses, to find the address for your local advisory group.
However, if the tax is to be paid to the Assistant
Commissioner (International), Form 1127 must be filed with
that office.

Period of Extension
An extension based on a tax due on a current return is
generally 6 months. However, an extension greater than 6
months may be granted if you are out of the country.
An extension based on an amount determined as a
deficiency is generally limited to 18 months from the date
payment is due. However, in exceptional circumstances, an
additional 12 months may be granted.
Note. An extension to pay a deficiency will not be granted if
the deficiency is due to negligence, intentional disregard of
rules and regulations, or fraud with intent to evade tax.

Payment Due Date
You must pay the tax before the extension runs out. Do not
wait to receive a bill from the IRS.
Interest. You will owe interest on any tax not paid by the due
date of the return, or the due date of any amount determined
to be a deficiency, regardless of whether an extension of time
to pay the tax has been obtained. The interest runs until you
pay the tax.
Penalties. Penalties may be imposed if you fail to pay the tax
within the extension period granted.

Corporations. Enter your company’s name, address, and
employer identification number.
Foreign Address. Enter the information in the following order:
City, province or state, and country. Follow the country’s
practice for entering the postal code. Do not abbreviate the
country name.

Part I
Enter the due date of your return or the due date of the
amount determined to be a deficiency. Enter the date you
propose to pay the tax. The proposed date may be up to:
● 6 months for an extension based on a tax due on a current
return, unless out of the country, or
● 18 months from the deficiency due date. (An additional 12
months may be requested for a deficiency in exceptional
circumstances.)

Part II
Undue hardship. Enter a detailed explanation outlining how
denial of this request will result in an undue hardship. An
undue hardship means more than inconvenience. You must
show that you will suffer a substantial financial loss (such as
selling property at a sacrifice price) if you pay your tax on the
date it is due.
You must show that you do not have enough cash, above
necessary working capital, to pay the tax. In determining cash
available, include anything you can convert into cash, using
current market prices.
Inability to borrow. Enter a detailed explanation explaining
what prevents you from borrowing to pay the tax owed by the
due date, except under terms that will cause you sever loss or
hardship.
Supporting documentation. You must attach:
1. A statement(s) of your assets and liabilities at the end of the
last month (showing book and market values of assets and
whether securities are listed or unlisted), and
2. An itemized list of your income and expenses for each of
the 3 months prior to the due date of the tax.

Security
Security is required to ensure the underlying tax is paid at the
end of the extension granted. Please indicate the type of
collateral you will use to secure the payment of your tax or
deficiency during this period. Collateral can include: a bond,
notice of lien, mortgage, deed of trust of specific property or
general assets, personal surety, etc. Ordinarily, you must
deposit the pledged collateral with the IRS when your
extension is approved.
Note. No collateral is required if you have no assets.

Signature and Verification
This form must be signed. If you are filing a joint return, both
of you must sign. If your spouse cannot sign the return, see
Pub. 501, Exemptions, Standard Deduction, and Filing
Information.

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1127, PAGE 3 of 4 (Page 4 is blank)
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 203 mm (8") x 559 mm (22") FOLD TO: 203 mm (8") x 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

1127
Form 1041 (Rev. 01-2009)

Page

Determination Chart
Use this chart to determine if Form 1127 is the correct form for
you to file.
IF you . . .

THEN . . .

Are seeking an extension of
time to file your income tax
return

File Form 4868, Application for
Automatic Extension of Time To
File U.S. Individual Income Tax
Return, or Form 2350,
Application for Extension of Time
To File U.S. Income Tax Return.
Do not file Form 1127.

Have already filed an income
tax return and are unable to
pay the tax by the due date of
the return

Call, write, or visit your local IRS
office to discuss your situation.
For more information, see
Publication 594, the IRS
Collection Process. Do not file
Form 1127.

Are requesting to make
installment payments

Complete Form 9465, Installment
Agreement Request, and attach
it to your tax return. Do not file
Form 1127.

Are seeking an extension of
time to pay estate tax

Are requesting to postpone the
payment of the full amount of
tax shown on your return or
any amount determined as a
deficiency by the due date
because of undue hardship

File Form 4768, Application for
Extension of Time To File a
Return and/or Pay U.S. Estate
(and Generation Skipping
Transfer) Taxes. Do not file
Form 1127.
File Form 1127 by the due date
of your return or by the due date
for the amount determined as a
deficiency.

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Paperwork Reduction Act Notice. We ask for the information
on this form to carry out the Internal Revenue laws of the
United States. You are required to give us the information. We
need it to ensure that you are complying with these laws and
to allow us to figure and collect the right amount of tax. You
are not required to provide the information requested on a
form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained
as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated burden
for individual taxpayers filing this form is approved under OMB
control number 1545-0074 and is included in the estimates
shown in the instructions for their individual income tax return.
The estimated burden for all other taxpayers who file this form
is shown below.
Recordkeeping
Learning about the
law or the form
Preparing and sending
the form to the IRS

10
31 min.
3 hr., 35
35 min.
55
48 min.
3 hr., 25

If you have comments concerning the accuracy of these
time estimates or suggestions for making this form simpler,
we would be happy to hear from you. See the instructions for
the tax return with which this form is filed.