Form 1127 Form 1127 Application for Extension of Time for Payment of Tax

1127

Form
(Rev. December 2011)
Department of the Treasury
Internal Revenue Service

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

OMB No. 1545-2131

Before you begin: Use the chart on page 3 to see if you should file this form.
Identifying number

Name(s) shown on return

Number, street, and apt., room, or suite no. If you have a P.O. box, see instructions.

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

Part I

Request for Extension

, 20
, to
I request an extension from
This request is for (check only one box):
The tax shown or required to be shown on Form
An amount determined as a deficiency on Form
This request is for calendar year 20
, or fiscal year ending

Part II

, 20

.

, to pay tax of $

.
.
, 20

.

Reason for Extension

Undue hardship. Enter below a detailed explanation of the undue hardship that will result if your application is denied. (If more space
is required, please attach a separate sheet.) To establish undue hardship, you must show that you would sustain a substantial
financial loss if forced to pay a tax or deficiency on the due date. For a complete definition of “undue hardship,” see the instructions
on page 3 under Who Should File.

Part III

Supporting Documentation

To support my application, I certify that I have attached (you must check both boxes or your application will not be accepted):
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

a

Date a

Signature of spouse

a

Date a

Signature of preparer
other than taxpayer

a

Date a

FOR IRS USE ONLY (Do not detach)
This application is

Approved

Denied

Returned:

Reason(s):

Date

Signature of authorized official
For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Cat. No. 17238O

Form

1127

(Rev. 12-2011)

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Form 1127 (Rev. 12-2011)

Page

3

Determination Chart

• Taxes on qualified investment entities.
• Taxes on greenmail.
• Taxes on structured settlement factoring transactions.
• Gift taxes.
Form 1127 can also be filed if you receive a notice and demand for
payment (or tax bill) 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.
• Taxes on private foundations and certain other tax-exempt
organizations.
• 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.
Note. If you need an extension to pay estate tax, file Form 4768.

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

When To File

Section references are to the Internal Revenue Code.

General Instructions
What's New
The IRS has created a page on IRS.gov for information about Form
1127 and its instructions at www.irs.gov/form1127. Information
about any recent developments affecting Form 1127 will be posted
on that page.

Purpose of Form
Use Form 1127 to request an extension of time under section
6161 for payment of the following amounts.
• The tax shown or required to be shown on a return.
• An amount determined as a deficiency (an amount you owe
after an examination of your return).

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.

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 a monthly
installment payment plan

See Form 9465, Installment
Agreement Request. Do not file
Form 1127.

Are requesting to postpone
payment of the full amount of
tax shown on your return or
any amount determined as a
deficiency

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

Owe any tax and are not
requesting, or do not qualify
for, either a monthly installment
payment plan or an extension of
time to pay the full amount

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.

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.

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 requesting an extension of time to pay the tax due on
an upcoming return, Form 1127 must be received on or before the
due date of that return, not including extensions.
If you are requesting an extension of time to pay an amount
determined as a deficiency, Form 1127 must be received on or
before the due date for payment indicated in the tax bill.

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 Pub. 4235, Collection
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
to pay the tax shown on a return. 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 to pay 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.

Page

Form 1127 (Rev. 12-2011)

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
Name, Address, and Identification Number
Individuals. Enter your name, address, and social security number
(SSN) or individual taxpayer identification number (ITIN). If this
application is for the tax shown on a joint return or a joint tax
liability for an amount determined as a deficiency, include both
spouses’ names in the order in which they appear or will appear on
your return, and enter the SSN or ITIN of the spouse whose name
appears first.
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
Request for extension. Enter the due date of your return (not
including extensions) or the due date for paying the amount
determined as a deficiency. Enter the date you propose to pay the
tax and the amount of tax you owe. The date you propose to pay
the tax can be up to:
• 6 months from the due date of your return (not including
extensions), if your request is for payment of the tax shown on your
return (the date you propose can be more than 6 months if you are
out of the country), or
• 18 months from the date payment is due, if your request is for
payment of an amount determined as a deficiency (an additional 12
months can be requested for a deficiency in exceptional
circumstances).
Check the applicable box and enter the form number to which the
tax you owe relates. Enter the tax year, if the tax you owe is figured
on a calendar year; if the tax you owe is figured on a fiscal year,
enter the ending month, day, and year.

Part II
Reason for extension. In order for your application to be
considered, you must provide a detailed explanation of the undue
hardship that will result if you pay the tax on or before the due date.
An extension will not be granted if you provide only a general
statement of 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 have to be met.

4

Signature and Verification
This form must be signed and dated.
Individuals. If this application is for the tax shown on a joint return
or a joint tax liability for an amount determined as a deficiency,
both you and your spouse must sign and date this form. If your
spouse cannot sign, 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 . . . . . . . . . . . . 3 hr., 6 min.
Learning about the
law or the form . . . . . . . . . . . . . . 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
for which this form is filed.