Address

Internal Revenue Service
Address that appears on their paper

Date: Certified Mail No.: ____________

Re _______ Notice postmarked (Date)

ENTITY MODULE: (Name and SS Number)

Greetings:

I received your _____ Notice dated ________ for tax period ending December 31, ____, a copy of which is attached. I am requesting that you allow me a thirty day extension of time in which to answer. No reply is necessary if extension is granted.

Best regards,

___________________