Form Rd 112 – Fill Out and Use This PDF

	WAGE EARNER
RD-112 (09/09)	CITY OF KANSAS CITY, MISSOURI
Phone (816) 513-1120	FINANCE DEPARTMENT
	REVENUE DIVISION
	414 EAST 12TH STREET
	2ND FLOOR EAST
	KANSAS CITY, MISSOURI 64106-2786

WAGE EARNER APPLICATION FOR AUTOMATIC EXTENSION

(A separate extension form must be filed for each account)

An extension is granted for a period of six (6) months. This is not an extension of time for payment of taxes. This is a request for additional time to file your return. An automatic extension of time to file will be granted upon the timely receipt of tax due (line 3C) and a completed application for extension. If the extension of time is not granted, you will receive a denial notice.

Extension payment must be 90% of the tax due to avoid penalty and interest

SECTION A

Name ________________________________________________________________________________

Mailing ________________________________________________________________________________

Address

City/State : _____________________________________________________ Zip: ____________________

Social Security Number: ______________________________________________________________________

Taxable Year: From : ____/____/____

TO: ____/____/_____

Extension payment must be 90% of the tax due to avoid penalty and interest

SECTION B

1. Is the taxable period less than 12 months?

( ) NO	( ) YES	If YES , Please explain____________________________________________________
		______________________________________________________________________

2.State in detail the reason why the extension is needed

_____________________________________________________________________________________________

_____________________________________________________________________________________________

___________________________________________________________________________________________

3. Tax Information:
a. Estimated Taxable earnings (or net profits) $			___________________________
b. Tax due (1% of line 3a)		$	___________________________
c. Amount paid (should be the same as 3b)		$	___________________________		(DO NOT SEND CASH)
Signature of Taxpayer	Print Name		Title	Date	Phone
Signature of Preparer	Print Name		Title	Date	Phone

FILETHISFORMONORBEFOREDUEDATEOFRETURN(PLEASESEEBACK)

Write your Social SecurityNumber or FEIN on check and make payable to CityTreasurer/Revenue.

GENERAL INSTRUCTIONS FOR RD-112

(A separate extension form must be filed for each account)

SECTION A

1.Every resident individual who derives income from salaries, wages, commissions or other compensation for which the tax has NOT been withheld by the resident’s employer(s) .

2.Every nonresident individual working or providing services within the city who derives income from salaries, wages, commissions, or other compensation from which the tax has NOT been withheld by the employer.

3.If your income is derived from the ownership of a business or other self-employment, you should complete the form RD-111 (Application for Automatic Extension for Profits Return).

4.The due date for final payment is April 15

5.Extension payment must be 90% of the tax due to avoid penalty and interest.

SECTION B

1.File this form on or before due date of return

2.Complete Section B regardless of whether you are requesting an extension of time to file a profits return. Extension payment must be 90% of the tax due to avoid penalty and interest.

3.An extension is granted for a period of six (6) months.

4.This is not an extension of time for payment of taxes. This is a request for additional time to file your return.

5.An automatic extension time to file will be granted upon timely receipt of tax due (line 3C) and a completed application for extension.

6.If the extension of time to file is not granted, you will receive a denial notice.

7.Form RD-112 and estimated taxes are due on or before the due date of return. RD-109 interest and penalties must be paid.

Please write your Social Security Number or Federal Identification number on check and

make your check payable to City Treasurer/Revenue and mail to: Revenue Division, 414 East 12th Street, 2nd Floor- East, Kansas City, MO 64106-2786

Visit our website at www.kcmo.org/revenue for more forms and instructions