Request for Tax Year - Select -20182019 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 Print
