SLW 0 WI Appt Entity

IMPORTANT
THIS FORM IS TO BE USED BY CORPORATE TAXPAYERS FOR PAYMENT OF INCOME TAX
AND/OR NET WORTH TAX WHEN AN EXTENSION HAS BEEN REQUESTED OR IS ENFORCED.

Instructions for Form IT 560C

When a taxpayer receives an automatic extension of time in which to file a Federal return, Georgia will honor that
extension. No penalty for late filing will be assessed if the Georgia return is filed by the extended due date of the
Federal return. The extension is for filing the return and does not extend the time for paying the tax. The tax must
be paid by the statutory due date. An extension of time for filing does not relieve the taxpayer of liability for interest
or penalty for late payment of tax.
1. This form is to be used to submit any payment of tax when an extension is requested or enforced.
2. The amount paid with this form should be claimed on the completed return as credits and payments.
3. This form must be submitted with remittance to pay the tax that will be due as reflected on the final return.
If the tax is not paid by the original due date of the return, a penalty of 1/2 of 1% per month of the tax due
will be assessed as a late payment penalty. The addition of this penalty does not relieve the taxpayer
of liability for interest due on the unpaid balance of tax.
4. The amount paid is to be credited as a payment on the liability that may be due as indicated on the
completed return. Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful
money of the United States, free of any expense to the State of Georgia.
For faster and more accurate posting to your account, use a payment voucher with a valid scanline from
Georgia Department of Revenues website http://dor.ga.gov or one produced by an approved software
company listed at http://dor.ga.gov
If you have any questions call: 1-877-423-6711
Make check payable to: Georgia Department of Revenue (Include FEI Number on check)
Mail the completed IT 560C with remittance to:
Processing Center
Georgia Department of Revenue
PO Box 740239
Atlanta, GA 30374-0239

Draft Form - Do Not File

Data Subject to Change

PLEASE DO NOT mail this entire page. Please cut along dotted line and mail only voucher and payment.
PLEASE DO NOT STAPLE. PLEASE REMOVE ALL CHECK STUBS.

Cut along dotted line

IT 560 C (Rev. 12/14)

MAIL TO:

FOR CORPORATION AND COMPOSITE ONLY

Processing Center
Georgia Department of Revenue
P O Box 740239
Atlanta, Georgia 30374-0239

Payment of Income Tax

Income/Net Worth Payment Voucher
Telephone No. 1-877-423-6711

Composite Tax

Corporate Income Tax

Net Worth Tax

Address Change

Name Change

FEI Number

Income Tax Year

Beginning Date

Ending Date

19-1234568

2015

01/01/2015

12/31/2015

Name (Type or print plainly the exact Corporation Name)

Signature of Officer or Agent

SLW 0 WI Appt Entity Long, SLW 0 WI Appt Entity Long 2

Vendor Code

040
Title

Date

President

Business Address

City

State

Zip Code

2 Court Square - 7th Floor, 2 Court Square - 7th Floor 2

Venice

FL

01970-7214

PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS.

Amount Paid

10

SLW 0 WI Appt Entity

Form

MAIL TO:

IT-303 (Rev. 12/2012)

Georgia Department of Revenue

Processing Center
PO Box 740320
Atlanta, GA 30374-0320

Georgia Department of Revenue

APPLICATION FOR EXTENSION OF TIME

FOR FILING STATE INCOME TAX RETURNS
IMPORTANT! ACCEPTANCE OF FEDERAL EXTENSIONS
A FEDERAL EXTENSION WILL BE ACCEPTED AS A GEORGIA EXTENSION IF: (1) THE RETURN IS RECEIVED WITHIN THE TIME AS EXTENDED BY
THE INTERNAL REVENUE SERVICE, AND (2) A COPY OF THE FEDERAL EXTENSION(S) IS ATTACHED TO THE RETURN WHEN FILED. NOTE:
THERE IS NO EXTENSION FOR PAYMENT OF TAX. INCOME TAX OR CORPORATE NET WORTH TAX MUST BE PAID BY THE PRESCRIBED DUE
DATE TO AVOID THE ASSESSMENT OF LATE PAYMENT PENALTIES AND INTEREST.

THIS IS NOT A PAYMENT FORM! REMIT PAYMENT ON FORM IT-560 OR IT-560C.

COMPLETE THIS FORM IN TRIPLICATE. MAIL THE ORIGINAL PRIOR TO THE RETURN DUE DATE AND KEEP 2 COPIES. ATTACH ONE COPY TO
RETURN WHEN FILED AND RETAIN ONE COPY FOR YOUR RECORDS. WE WILL NOTIFY YOU ONLY IF YOUR EXTENSION REQUEST IS DENIED.

SECTION 1
NAME

SOCIAL SECURITY NUMBER OR FEIN

SLW 0 WI Appt Entity Long, SLW 0 WI Appt Entity Long 2

19-1234568

ADDRESS

CITY

STATE

ZIP CODE

2 Court Square - 7th Floor, 2 Court Square - 7th Floor 2

Venice

FL

01970-7214

NAME OF TAXPAYER FOR WHOM EXTENSION IS FILED, IF DIFFERENT FROM ABOVE

Tejas Choksi
ADDRESS

CITY

STATE

ZIP CODE

nadiad

nADIAD

GA

3870

SECTION 2
APPLICATION IS HEREBY MADE FOR AN EXTENSION OF TIME FOR THE FOLLOWING STATE TAX RETURN:
1. Type of return (check proper type):

2. For Period Ending:

3. Extension Requested To:

Draft Form - Do Not File

Data Subject to Change

Individual--Form 500

Partnership--Form 700 (5 months only)

Fiduciary--Form 501 (5 months only)

Corporate Income Tax

Net Worth Tax (For Period Beginning) 01/01/2016
Other
1/1/2015

12/31/2015

09/15/2016

12/31/2016

09/15/2016

1/1/2015

12/31/2015

NOTE: Except as noted above, extensions are limited by law to six (6) months, please see line 6 of instructions.

SECTION 3
REASON FOR EXTENSION:
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I AFFIRM THAT THE ABOVE INFORMATION IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE AND ACCURATE. THIS AFFIRMATION
IS MADE UNDER THE PENALTIES PRESCRIBED BY LAW.

DATE

SIGNATURE OF TAXPAYER OR AUTHORIZED AGENT

SM Corporation
IF SIGNED BY AGENT, AGENTS FIRM OR TRADE NAME