Application for Automatic Extension of Time OMB No.

1545-0074
Form 4868
Department of the Treasury To File U.S. Individual Income Tax Return 2016
Internal Revenue Service (99) Information about Form 4868 and its instructions is available at www.irs.gov/form4868.

Date to file by: 04-18-2017

Payment: $0

Payment Method: Your payment can be by either check or money order

payable to the "United States Treasury." Include
your SSN, daytime phone number, and "2016 Form 4868"
on your check or money order. Do not send cash. To
pay by credit card, go to www.1040paytax.com.

Address to file: Department of the Treasury

Internal Revenue Service
Fresno, CA 93888-0045

Other Instructions: An extension to file does not extend the time to pay
your tax. You can also e-file Form 4868 and make
payment by authorizing an electronic funds
withdrawal from your checking or savings account.

Taxpayer Records:

Amount Paid ____________________

Check Number ____________________

Date Mailed ____________________

Detach this entire note (cut on dotted lines) and enclose w ith the payment and the 4868 voucher (below ) ONLY
if Form 4868 was e-filed and ACCEPTED; otherwise, detach the 4868 voucher (cut on the lower dotted line) and
submit only the voucher with the payment.
NOTE

NOTE
The extension request was originally filed electronically.
DETACH HERE

Application for Automatic Extension of Time OMB No. 1545-0074

Form 4868
Department of the Treasury To File U.S. Individual Income Tax Return 2016
Internal Revenue Service (99) For calendar year 2016, or other tax year beginning , 2016, ending , .
Part I Identification Part II Individual Income Tax
4 Estimate of total tax liability for 2016 . . . . $ 0
5 Total 2016 payments . . . . . . . . . . . . 0
Diosdado Marto Morfa 6 Balance due. Subtract line 5 from line 4
2917 Winchester Dr APT B (see instructions) . . . . . . . . . . . . . . 0
ValparaisoValparaiso IN 46383 7 Amount you are paying (see instructions) .
8 Check here if you're "out of the country" and a U.S.
2 Your social security number 3 Spouse's social security number citizen or resident (see instructions) ...........
660-28-5105 9 Check here if you file Form 1040NR or 1040NR-EZ and
didn't receive wages as an employee subject to U.S.
income tax withholding . . . . . . . . . . . . . . . . . .
For Privacy Act and Paperwork Reduction Act Notice, see page 4. Form 4868 (2016)
EEA

660285105 DW MART 30 0 201612 670

 Payment Voucher Filing Instructions 2016

Date to file by: 04-18-2017

Payment: $824

Address to file: Internal Revenue Service

P.O. Box 802501
Cincinnati, OH 45280-2501

Other Instructions: If paper-filing your 2016 return, mail the tax

return, voucher, and check to the address on the
voucher. Do not staple the voucher and payment to
the return or to each other.

If your return was e-filed, mail the voucher and

check to the address on the voucher.

Make your check or money order payable to "United

States Treasury". Enter your SSN and "2016 Form
1040" on your check or money order.

To pay by credit card, go to www.1040paytax.com.

Taxpayer Records:

Amount Paid ____________________

Check Number ____________________

Date Mailed ____________________

Form 1040-V (2016)

Detach Here and Mail With Your Payment and Return

1040-V
Form

OMB No. 1545-0074

Payment Voucher
Department of the Treasury
Internal Revenue Service (99) Do not staple or attach this voucher to your payment or return.
2016
1 Your social security number (SSN) 2 If a joint return, SSN shown second 3 Amount you are paying by Dollars Cents
(if a joint return, SSN shown first on your return) on your return check or money order. Make
your check or money order pay-
660-28-5105 able to "United States Treasury" 824
EEA

Diosdado Marto Morfa Internal Revenue Service

2917 Winchester Dr APT B P.O. Box 802501
ValparaisoValparaiso, IN 46383 Cincinnati, OH 45280-2501
For Paperwork Reduction Act Notice, see your tax return instructions.

660285105 DW MART 30 0 201612 610