Form 8809-EX Request for Extension of Time To File an ExSTARS Informa

Version A, Cycle 7

Form

8809-EX

Request for Extension of Time To
File an ExSTARS Information Return

(January 2014)

OFFICIAL USE ONLY

(For Form 720TO or Form 720CS)

Department of the Treasury
Internal Revenue Service

Print
or
Type

OMB No. 1545-XXXX

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Information about Form 8809-EX and its instructions is at www.irs.gov/form8809ex.

Determination Date
Approved
Denied

1. Filer information
Name

2. Employer identification number

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

Form 637 registration number

City

State

Contact name

Telephone number

4. Type of extension request (check one)
Form 720TO

ZIP code

3. Filing period

5. Request type (check one)

Form 720CS

Combined filing

Initial

Additional

Note. File this form by the required return due date.
6. Extension request reason: Provide a brief but clear reason for the extension request. The IRS will automatically deny an application for an
extension that is submitted without a reason(s). Use additional sheets if necessary and include your name and employer identification number on
each page. For a combined filing, provide a reason for the extension request for each return.

Internal Use Only
DRAFT AS OF
December 10, 2013
Under penalties of perjury, I declare that I have examined this form, including any accompanying statements, and, to the best of my knowledge and belief, it is true, correct, and
complete.

Signature ▶

Title ▶

Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments
For the latest information about developments related to Form
8809-EX and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/form8809EX.

General Instructions
Purpose of form. Use Form 8809-EX to request a 30-day extension
of time to file an Excise Summary Terminal Activity Reporting
System (ExSTARS) information report (Form 720TO, Terminal
Operator Report, or Form 720CS, Carrier Summary Report).
For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Date ▶

How to file. All requests must include an extension reason. All initial
30-day requests will be honored except for those without a reason.
When to file. File this form with the IRS on or before the due date of
the return. If you are requesting an extension of time to file both
Form 720TO and Form 720CS, you may use one Form 8809-EX.
Extension period. The automatic extension is 30 days from the
original due date. You may request one additional extension of not
more than 30 days by submitting a second Form 8809-EX before
the end of the first extension period (see Line 5, later). Requests for
an additional extension of time to file information returns are not
automatically granted. Generally, the IRS will not grant additional
time except in cases of extreme hardship or catastrophic event.

Cat. No. 62959G

Form 8809-EX (1-2014)

Version A, Cycle 7
Page 2

Form 8809-EX (1-2014)

If we deny your request, we will send a letter to your address on
record with an explanation for denial. Failure to update a change of
address may result in a late filing penalty. See Where To File, below,
for the address to send your change of address or any other
ExSTARS correspondence. If we do not send you a letter of denial,
you may consider your extension request to be approved.
Extension denials. If we deny an application for extension of time
to file, the information provider must file the return by the required
filing date or within 1 business day from the official denial date,
whichever is later.
Penalty. If you file required information returns late and you have
not applied for and received an approved extension of time to file,
you may be subject to a late filing penalty. The amount of the
penalty is based on when you file the correct information return.

Where To File
Specific Instructions
Line 1. Filer Information, and Form 637 Registration
Number
Enter the name and complete mailing address, including room or
suite number used to file your ExSTARS returns or the address on
your most recently submitted change of address.
Form 637 registration number. Enter the assigned IRS number.
Regulations sections 48.4101-1(c)(1)(iii)(iv)(vi) and (vii) require
terminal operators and bulk transport carriers to be registered by
the IRS. If you do not have a registration number, use Form 637,
Application for Registration (For Certain Excise Tax Activities), to:

Internal Revenue Service
Attn: Excise Unit-Stop 5701G
Cincinnati, OH 45999

CAUTION

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. Form 8809-EX is provided by the IRS to request an
extension of time to file information returns. Section 6081 and its
regulations require you to provide the requested information if you
desire an extension of time for filing an information return. If you do
not provide the requested information, an extension of time for filing
an information return may not be granted. Section 6109 requires
you to provide your employer identification number (EIN). Routine
uses of this information include giving it to the Department of
Justice for civil and criminal litigation, and to cities, states, the
District of Columbia, and U.S. commonwealths and possessions for
use in administering their tax laws. We may also disclose this
information to other countries under a tax treaty, or to federal and
state agencies to enforce federal nontax criminal laws, or to federal
law enforcement and intelligence agencies to combat terrorism.
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 average time
is:
Recordkeeping . . . . . . . . . . . . X hrs., X min.
Learning about the law or the form . . . . . . . X min.
Preparing and sending the form to the IRS . . . . . X 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. You can write to:
Internal Revenue Service
Tax Forms and Publications
SE:W:CAR:MP:TFP
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send the form to this address. Instead, see Where To File
above.

Internal Use Only
DRAFT AS OF
December 10, 2013
Mail

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Line 3. Enter the filing period for which you are requesting an
extension of time.
Line 4. Check the box for the form for which an extension is
requested or the box marked “Combined filing,” if an extension for
both returns is requested. Check only one box.
Line 5. Check the box marked “Initial” if this is your first request for
an extension of time. Check the box marked "Additional" if you have
already received the initial 30-day extension, and you need an
additional extension for the same return(s).

Email

[email protected]

The name and employer identification number (EIN)
must match the name and EIN used on your ExSTARS
returns.

Enter the name of a person who is familiar with this request whom
we can contact if additional information is required. Please provide
that person's telephone number and email address.
Line 2. You must provide your employer identification number
(EIN). Social Security Numbers and "Applied For" type designations
are not valid. If you do not have an EIN, you may apply for one
online. Go to the IRS website at www.irs.gov/businesses/small and
click on the "Employer ID Numbers (EINs)" link.
Enter your 9-digit EIN in the appropriate box. Enter the EIN
associated with the ExSTARS activities.