Individual Income Tax Return
Information about Form 4868 and its instructions is available at www.irs.gov/form4868
Form 4868
Department of the Treasury
Internal Revenue Service (99)
OMB No 1545-0074, :
Payment:
Payment Method:
Address to file:, $0
Your payment can be by either check or money order
payable to the "United States Treasury." Include
your SSN, daytime phone number, and "2013 Form 4868"
on your check or money order
Do not send cash
To
pay by credit card, go to www.1040paytax.com
Department of the Treasury
Internal, Instructions: An extension to file does not extend the time to pay
your tax
You can also e-file Form 4868 and make
payment by authorizing an electronic funds
withdrawal from your checking or savings account
Taxpayer Records:
Amount Paid
Check Number
Date Mailed
V DETACH HERE V
Form
Department of the Treasury
Internal Revenue Service (99)Application for Automatic Extension of Time
To File U.S
Individual Income Tax Return
For calendar year 2013, or other tax year beginning ,2M3,ending, Part I Identification Part II Individual Income TaxEstimate of total tax liability for 2013Total 2013 payments
1,322
VICKRAM SINGH23rd Street Suite A, 32960Balance due
Subtract line 5 from line 4
(see instructions)Amount you are paying (see instructions)
2 Your social security number70-0574Spouse's social security numberCheck here if you are "out of the country" and a U.S
Citizen or resident (see instructions) nCheck here if you file Form 1040NR or 1040NR-EZ and
did not receive wages as an employee subject to U.S
Income tax withholding
nFor Privacy Act and Paperwork Reduction Act Notice, see page 4