Form 1127 (Rev. 12-2011)
Page 4
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.
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.
