Request for Tax Year - Select -20212022 Select the tax year for your request. Employer Legal Name Address Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 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
