Form 4768 (Rev. August 2012) Department of the Treasury Internal Revenue Service Application for Extension of Time To File a Return and/or Pay U.S. Estate (and Generation-Skipping Transfer) Taxes Decedent's last name Date of death OMB No. 1545-0181 Part I Identification Decedent's first name and middle initial Name of executor Name of application filer (if other than the executor) Decedent's social security number Address of executor (Number, street, and room or suite no.) Estate tax return due date City, state, and ZIP code Domicile of decedent (county, state, and ZIP code) Daytime telephone number Part II Extension of Time To File Form 706, 706-A, 706-D, 706-NA, or 706-QDT (Section 6081) Automatic Extension . . . . . . . . If you are applying for an automatic 6-month extension of time to file: � Form 706, check here ......................... � Form 706-A, 706-D, 706-NA, or 706-QDT, indicate the form by checking the appropriate box below. Form 706-A Form 706-D Form 706-NA Form 706-QDT Additional Extension If you are an executor out of the country applying for an extension of time to file in excess of 6 months, check here . . . . . . Also you must attach a statement explaining in detail why it is impossible or impractical to file Form Enter extension date requested 706 by the due date. See instructions. Part III Extension of Time To Pay (Section 6161) Enter extension date requested (Not more than 12 months) You must attach your written statement to explain in detail why it is impossible or impractical to pay the full amount of the estate (or GST) tax by the return due date. If the taxes cannot be determined because the size of the gross estate is unascertainable, check here and enter "-0-" or other appropriate amount on Part IV, line 3. You must attach an explanation. � If this request is for the tax that will be or was due with the filing of Form 706, check here . . . . . . . � If this request is for the tax that will be due as a result of an amended or supplemental Form 706, check here � If this request is for additional tax due as a result of an examination of your Form 706, check here . . . . � If this request is for a section 6166 installment payment, check here ............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part IV 1 2 3 Payment To Accompany Extension Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 3 Amount of estate and GST taxes estimated to be due . . Amount of cash shortage (complete Part III) . . . . . Balance due (subtract line 2 from line 1) (see instructions) . Signature and Verification If filed by executor--Under penalties of perjury, I declare that I am an executor of the estate of the above-named decedent and that to the best of my knowledge and belief, the statements made herein and attached are true and correct. Executor's signature Title Date If filed by someone other than the executor--Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements made herein and attached are true and correct, that I am authorized by an executor to file this application, and that I am (check box(es) that apply(ies)): A member in good standing of the bar of the highest court of (specify jurisdiction) A certified public accountant duly qualified to practice in (specify jurisdiction) A person enrolled to practice before the Internal Revenue Service. A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested.) Filer's signature (other than the executor) Date Cat. No. 41984P Form For Paperwork Reduction Act Notice, see separate instructions. 4768 (Rev. 8-2012) American LegalNet, Inc. www.FormsWorkFlow.com Form 4768 (Rev. 8-2012) Decedent's first name and middle initial Decedent's last name Page Decedent's social security number 2 Part V Notice to Applicant--To be completed by the Internal Revenue Service Note. If applying for an extension of time to pay, file this page in duplicate. The application for extension of time to pay (Part III) is: Approved Not approved because (see instructions for your appeal rights) Other Internal Revenue Service official Address Date Name (print) Title (print) Signature: Form 4768 (Rev. 8-2012) American LegalNet, Inc. www.FormsWorkFlow.com