Texas Form 05 164 – Fill Out and Use This PDF

Tcode 13258 AnnualFranchise

Taxpayer number		Report year	Due date

Taxpayer name					Secretary of State file number
					or Comptroller file number
Mailing address
City	State	Country	ZIP Code	Plus 4	Blacken circle if the
					address has changed
Blacken circle if this is a combined report

If this extension is for a combined group, you must also complete and submit Form 05-165.

Note to mandatory Electronic Fund Transfer(EFT) payers:

When requesting a second extension do not submit an Affiliate List Form 05-165.

1. Extension payment (Dollars and cents)	1.

	Print or type name		Area code and phone number
			(	)	-
	I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief.			Mail original to:
			Texas Comptroller of Public Accounts
		Date		P.O. Box 149348
				Austin, TX 78714-9348

If you have any questions regarding franchise tax, you may contact the Texas Comptroller's field office in your area or call 1-800-252-1381.

Instructions for each report year are online at www.window.state.tx.us/taxinfo/taxforms/05-forms.html.

Taxpayers who paid $10,000 or more during the preceding fiscal year (Sept. 1 thru Aug. 31) are required to electronically pay their franchise tax.

For more information visit www.window.state.tx.us/webfile/req_franchise.html.

Texas Comptroller Official Use Only

VE/DE

PM Date