Request for Tax Year - Select - 2022 2023 Select the tax year for your request. Employer Legal Name Address Address City State - None - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Email Phone If you are requesting an extension for more than one permit, provide a list of employer legal names below. Enter the names and addresses consecutively in the field below. Separate entries by using a : (colon). Example--ABC Company, 123 Main Street, Anytown, Iowa, 55555: Employers If you are requesting a filing extension you must provide a detailed explanation of why you need additional time to file. IDR may, in a case involving hardship, extend the requirement to electronically file. Reason for extension 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 Date Leave this field blank Print