Form 1127 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 (PAGE 2 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

Date

Form

1127

Action

Date

O.K. to print
Revised proofs
requested

Application for Extension of Time for Payment of
Tax Due to Financial Hardship

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

Signature

OMB No. 1545-2131

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Before you begin: Use the chart on page 4 to see if you should file this form.
Name(s) shown on return

Your social security number or employer identification number

Number, street, and apt., room, or suite no. If P.O. Box, see instructions.

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

,

, to

(Enter the due date of the return or the deficiency due date)

reported on Form

.

This request is for calendar year

Part II

, to pay tax of $

(Enter the date you request to pay the tax)

Reason for Extension

or fiscal year ending

,

.

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 separate sheet.)

Part III
II Supporting documentation
To support my request, I certify that I have attached (you must check both boxes):
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
An itemized list of my income and expenses for each of the 3 months prior to the due date of the tax.

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 ©

©

Date ©

Signature of preparer
©
other than taxpayer

Date ©

Signature of spouse

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

Cat. No. 17238O

Form

1127

(Rev. 9-2009)

9
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1127, PAGE 3 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

Form 1127 (Rev. 9-2009)

Page

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Section references are to the Internal Revenue Code.

● Taxes on private foundations and certain other tax-exempt
organizations.

General Instructions

● Taxes on qualified investment entities.
● Taxes on greenmail.

Purpose of Form

Use Form 1127 to request an extension of time under section
6161 for payment of the following amounts.

● Taxes on structured settlement factoring transactions.
● Gift taxes.

● Tax shown or required to be shown on a return.
● An installment payment for a tax shown or required to be
shown on a return.
● An amount determined as a deficiency.
● Any portion of a claim for tax under chapters 1 or 12 of the
Internal Revenue Code which is part of a case under Chapter 11
of the United States Code or in receivership proceedings.

● An installment payment of income or self-employment income
taxes.
Form 1127 can also be filed if you receive a notice of deficiency
for any of the taxes shown below and paying them at the time
they are due will cause an undue hardship.
● Normal taxes and surtaxes.

Determination Chart

● Taxes on qualified investments.
● Gift taxes.
Undue hardship. The term “undue hardship” means more than
an 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.

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 Pub.
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

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.

Are requesting to postpone the
payment of the full amount of
tax shown on your return, an
installment payment of a tax
shown on your return, any
amount determined as a
deficiency, or a claim which is
part of a case under chapter
11 or in receivership by the
due date because of undue
hardship

3

File Form 1127 by the due date
of your return or by the due date
for the amount determined as a
deficiency.

Who Should File
You can file Form 1127 if you will owe any of the following and
paying the tax at the time it is due will cause an undue hardship.
● Income taxes.
● Self-employment income taxes.
● Withheld taxes on nonresident aliens and foreign corporations.

● Taxes on private foundations and certain other tax-exempt
organizations.

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 documentation, 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 due is a gift tax reportable on Form 709,
send Form 1127 to:
Department of the Treasury
Internal Revenue Service Center
Cincinnati, OH 45999

Extension Period
An extension of more than 6 months generally will not be granted
for payment of tax on a return or for payment of any installments
of such tax. However, except for taxes due under sections 4981,
4982, and 5881, an extension for more 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.

9
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1127, PAGE 4 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

Form 1127 (Rev. 9-2009)

Payment Due Date

Page

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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.

Specific Instructions

4

Name, Address, and Identification Number

Individuals. Enter your name, address, and social security
number or individual taxpayer identification number. If you plan to
file a joint return, include both spouses’ names in the order in
which they will appear on the return.
Corporations. Enter your company’s name, address, and
employer identification number.

P.O. Box. Enter your box number only if your post office does not
deliver to your street address.
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 from the date fixed for payment of the tax or
installment for an extension based on a tax due on a current
return, unless out of the country, or
● 18 months from the date fixed for payment of the tax
deficiency. (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.

Part III
Supporting documentation. You must attach:
● A statement(s) of your assets and liabilities, and
● An itemized list of your income and expenses for each of the 3
months prior to the due date of the tax.
Note. Once your request has been reviewed, additional
conditions may be required to be met.

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.

Privacy Act and Paperwork Reduction Act Notice. We ask for
the information on this form to carry out the Internal Revenue laws
of the United States. We need this information to ensure
compliance with these laws and to properly grant extensions of
time to pay tax. Applying for an extension of time for the payment
of tax is voluntary. However, providing the requested information
is mandatory if you apply for the extension. Our legal right to ask
for the information requested on this form is based in sections
6001, 6011, 6109, and 6161 and their regulations. If you fail to
provide all or part of the information requested, your application
may be denied. If you provide false or fraudulent information, you
may be subject to penalties.
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. However, section
6103 allows or requires the Internal Revenue Service to disclose
the information to others as described in the Code. For example,
we may disclose this information to the Department of Justice for
enforcement of civil or criminal tax laws; to cities, states, the
District of Columbia, and U.S. commonwealths or possessions to
administer their tax laws; to other countries under a tax treaty; to
federal and state agencies to enforce non-tax criminal laws; or to
federal law enforcement and intelligence agencies to combat
terrorism.
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

3 hr., 35 min.
55 min.

Preparing and sending
the form to the IRS
3 hr., 25 min.
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.