Form Form Form Form
4720 5227 6069 8870
● The books are in the care of ) ( ) ( FAX No. Telephone No. ● If the organization does not have an office or place of business in the United States, check this box ● If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) for the whole group, check this box . . . . . . . If it is for part of the group, check this box . . . . . . a list with the names and EINs of all members the extension will cover. 1
. If this is and attach
I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time until , 20 , to file the exempt organization return for the organization named above. The extension is for the organization's return for: calendar year 20 or , 20 , and ending , 20 . tax year beginning If this tax year is for less than 12 months, check reason: Initial return Final return Change in accounting period
2
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions.
3a $ 3b $
3c $ Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions.
For Privacy Act and Paperwork Reduction Act Notice, see Instructions.
Cat. No. 27916D Form
8868
(Rev. 4-2009)
Form 8868 (Rev. 4-2009)
Page
2
● If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868. ● If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).

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