Commonwealth of Massachusetts Department of Revenue

Commonwealth of Massachusetts
Department of Revenue

2015 Tax Year
Computer-Generated
Payment Voucher and Extension

Forms

(Form PV, Form M-4868, Form 2 PV, Form 355 PV, Form 355S PV
Form 355-7004, Form 355-7004 Misc, Form M-990T-7004 Misc)

02-05-2016 Version 15.03

Table Of Contents Page

1.0 2015 Form PV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.0 2015 Form M-4868. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3.0 2015 Form 2-PV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4.0 2015 Form 355-PV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
5.0 2015 Form 355S-PV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
6.0 2015 Form 355-7004. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
7.0 2015 Form 355-7004 Misc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
8.0 2015 Form M-990T-7004 Misc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Change Log

11-03-2015: Standard annual changes to indicate forms are for tax year 2015
01-12-2016: Addition of Corporate forms to the document
02-05-2015: Addition of 355-7004 Misc and M-990T-7004 Misc forms to the document

5 DETACH HERE  5

Form PV Income Tax Payment Voucher — 2015 Massachusetts
Department of Revenue
Social Security number Spouse’s Social Security number Year end date
Amount enclosed

Staple Check which form you filed:
check Form 1
here Form 1-NR/PY
Nonresident Composite Return
Name/address changed since 2014

Pay online at www.mass.gov/dor/payonline. Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7002, Boston, MA 02204.

5 DETACH HERE  5

Form M-4868 Application for Automatic Six-Month Extension — 2015 Massachusetts
Department of Revenue
Social Security number Spouse’s Social Security number Period end date
Amount enclosed

Sign here. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.

Your signature Signature of paid preparer Date

Employer Identification number of paid preparer Social Security number or PTIN

Form 2-PV 5 DETACH HERE  5 Massachusetts
Department of Revenue
U.S. taxpayer number Fiduciary Tax Payment Voucher — 2015
Amount enclosed
Year end date

Name/address changed since 2014

Pay online at www.mass.gov/dor/payonline. Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7018, Boston, MA 02204.

5 DETACH HERE  5

Form 355-PV Massachusetts Corporate Tax Payment Voucher 2015

Corporation name Federal Identification number Payment for the year ending: YEAR

//

MONTH DAY

Tax type Voucher type ID type Vendor code

STAPLE CHECK HERE 014 01 004 0001

Street address

City/ Town State Zip Amount enclosed
$

Check if name/address changed since 2014

Pay online at mass.gov/dor/payonline. Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7005,

5 DETACH HERE  5

Form 355S-PV Massachusetts Corporate Tax Payment Voucher 2015

Corporation name Federal Identification number Payment for the year ending: YEAR

//

MONTH DAY

Tax type Voucher type ID type Vendor code

STAPLE CHECK HERE 014 01 004 0001

Street address

City/ Town State Zip Amount enclosed
$
Pay online at mass.gov/dor/payonline. Or, return this voucher with check or money order payable to:
Commonwealth of Massachusetts, and mail to: Massachusetts Department of Revenue, PO Box 7005, Check if name/address changed since 2014

2015 0167 136

Form 355-7004 Rev. 10/02
Corporate Extension Worksheet Massachusetts
Department of
Revenue

Tentative Return

1 Estimated amount of tax for the taxable year (must be at least minimum tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Advance and/or estimated payments made (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tax due with this application. Subtract line 2 from line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Payment in full of the tax due must be made with the extension request for it to be considered valid. If at least 50% of the tax due or the minimum tax (whichever
is greater) for the taxable year is not paid, the extension is null and void. Penalties for a late return will be assessed from the original due date of the return.

General Information tax (whichever is greater) for the taxable year is not paid, the exten-
sion is null and void. If filing Form 355U, payments may be allocated
New Streamlined Extension Process for to subsidiaries when Schedule CG is filed.
Corporate Excise Taxpayers
The extension process is now automated so that all corporate excise Will Interest and Penalties Be Due?
taxpayers will be given an extension of time to file their tax returns as An extension of time to file a corporation tax return does not extend
long as certain payment requirements are met. Generally, to meet the due date for payment of the tax. Interest will be charged on any
these payment requirements, corporate excise taxpayers must have tax not paid on or before the original due date. Any tax not paid within
paid the greater of (1) 50% of the total amount of tax ultimately due or the extended period is subject to a penalty of 1% per month, up to a
(2) the minimum corporate excise by the original due date for filing the maximum of 25%, from the extended due date.
return. Consistent with current rules, taxpayers meeting these pay-
ment requirements will be given a seven-month extension in the case How Long Is the Period of Extension?
of corporate excise taxpayers filing combined reports and a six-month An automatic six-month extension is granted upon the proper filing
extension in the case of other corporate excise taxpayers. However, of this form. An extension for a period longer than six-months
taxpayers filing unrelated business income tax returns will be given may be granted if good cause exists; it requires the written approval
an eight-month extension. See TIR 15-15 for more information. of the Commissioner before it becomes effective. The Commissioner
may terminate this extension at any time by mailing a notice of termi-
When Should Form 355-7004 Be Filed? nation to the corporation or to the person who requested the exten-
This application must be filed on or before the 15th day of the third sion for the corporation. The notice will be mailed at least 10 days
month after the close of the taxable year, calendar or fiscal. prior to the termination date designated in the notice.

Must a Payment Be Submitted with This Form?
Yes. The full payment of tax reasonably estimated to be due must
accompany this form. If at least 50% of the tax due or the minimum

DETACH HERE

Form 355-7004 Application for Corporate Extension — 2015 Massachusetts
Department of Revenue
Federal Identification number Is the corporation incorporated in Massachusetts? Period end date Amount enclosed
Yes No
Tax type ID type Vendor code
014 Voucher type 004 0001
Business name 18 Type of extension being applied for

Mailing address a. Automatic six-month b. Extension until: State Zip
City/Town

Sign here. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.

Signature of officer or agent Signature of paid preparer Date

Employer Identification number of paid preparer Social Security number or PTIN of paid preparer

2015 0167 104

Who May Sign? Note: Under certain circumstances, if a payment is not required to
Form 355-7004 must be signed by the treasurer or assistant trea- be submitted with the extension request, the requirement to file the
surer of the corporation or by a person authorized by the corpora- extension may be waived. For further information, see TIR 06-21.
tion to do so. An application signed by an unauthorized person will
be considered null and void. If a return is filed after the original due Corporations with $100,000 or more in receipts or sales must submit
date based on a void extension, interest and penalties will be as- their extension request, as well as any accompanying payment, elec-
sessed back to the original due date. tronically. Also, any corporation making an extension payment of
$5,000 or more must make the payment using electronic means. For
Keep this worksheet with your records. Do not submit it with Form further information, see TIR 04-30.
355-7004. Mail the completed application to: Massachusetts De-
partment of Revenue, PO Box 7025, Boston, MA 02204.

Form 355-7004 Misc. Rev. 10/02
Application for Extension of Massachusetts
Time to File Financial Institution, Department of
Insurance or Miscellaneous Revenue

This application may be filed by corporations filing Form 63FI, 63-20P, 63-23P, 121A or 63-29A. All other business/manufacturing corporations that
file Forms 355, 355S, 355U, 355SC or SBC Corporation Excise Returns must file Form 355-7004 when applying for an extension of time to file.

If you are mandated to file and pay electronically do not file this form. See TIR 15-9.

Tentative Return

1 Estimated amount of tax for the taxable year (must be at least minimum tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Advance and/or estimated payments made (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tax due with this application. Subtract line 2 from line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Payment in full of the tax due must be made with the extension request for it to be considered valid. If at least 50% of the tax due or the minimum tax (whichever
is greater) for the taxable year is not paid, the extension is null and void. Penalties for a late return will be assessed from the original due date of the return.

General Information Must a Payment Be Submitted with This Form?
Yes. The full payment of tax reasonably estimated to be due must
New Streamlined Extension Process for accompany this form. If at least 50% of the tax due or the minimum
Corporate Excise Taxpayers tax (whichever is greater) for the taxable year is not paid, the exten-
The extension process is now automated so that all corporate excise sion is null and void.
taxpayers will be given an extension of time to file their tax returns as
long as certain payment requirements are met. Generally, to meet Will Interest and Penalties Be Due?
these payment requirements, corporate excise taxpayers must have An extension of time to file a corporation tax return does not extend
paid the greater of (1) 50% of the total amount of tax ultimately due or the due date for payment of the tax. Interest will be charged on any
(2) the minimum corporate excise by the original due date for filing the tax not paid on or before the original due date. Any tax not paid within
return. Consistent with current rules, taxpayers meeting these pay- the extended period is subject to a penalty of 1% per month, up to a
ment requirements will be given a seven-month extension in the case maximum of 25%, from the extended due date.
of corporate excise taxpayers filing combined reports and a six-month
extension in the case of other corporate excise taxpayers. However, How Long Is the Period of Extension?
taxpayers filing unrelated business income tax returns will be given An automatic six-month extension is granted upon the proper filing
an eight-month extension. See TIR 15-15 for more information. of this form. An extension for a period longer than six-months
may be granted if good cause exists; it requires the written approval
When Should Form 355-7004 Misc. Be Filed? of the Commissioner before it becomes effective. The Commissioner
This application must be filed on or before the 15th day of the third
month after the close of the taxable year, calendar or fiscal.

DETACH HERE

Form 355-7004 Misc. Application for Corporate Extension — 2015 Massachusetts
Department of Revenue
Federal Identification number Is the corporation incorporated in Massachusetts? Period end date Amount enclosed
Tax type Yes No
Business name ID type Vendor code
Mailing address Voucher type 004
18 Type of extension being applied for

a. Automatic six-month b. Extension until: State Zip
City/Town

Sign here. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.

Signature of officer or agent Signature of paid preparer Date

Employer Identification number of paid preparer Social Security number or PTIN of paid preparer

may terminate this extension at any time by mailing a notice of termi-
nation to the corporation or to the person who requested the exten-
sion for the corporation. The notice will be mailed at least 10 days
prior to the termination date designated in the notice.

Who May Sign?
Form 355-7004 Misc. must be signed by the treasurer or assistant
treasurer of the corporation or by a person authorized by the corpo-
ration to do so. An application signed by an unauthorized person will
be considered null and void. If a return is filed after the original due
date based on a void extension, interest and penalties will be as-
sessed back to the original due date.

Keep this worksheet with your records. Do not submit it with Form
355-7004 Misc. Mail the completed application to: Massachusetts
Department of Revenue, PO Box 7025, Boston, MA 02204.

Corporations with $100,000 or more in receipts or sales must submit
their extension request, as well as any accompanying payment, elec-
tronically. Also, any corporation making an extension payment of
$5,000 or more must make the payment using electronic means. For
further information, see TIR 04-30.

Form M-990T-7004 Rev. 10/02
Unrelated Business Income Tax Massachusetts
Department of
Extension Worksheet Revenue

If you are mandated to file and pay electronically do not file this form. See TIR 15-9.

Tentative Return

1 Estimated amount of tax for the taxable year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Advance and/or estimated payments made (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tax due with this application. Subtract line 2 from line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Payment in full of the tax due must be made with the extension request for it to be considered valid. If at least 50% of the tax due for the taxable year is not
paid, the extension is null and void. Penalties for a late return will be assessed from the original due date of the return.

General Information

New Streamlined Extension Process for Who May File Form M-990T-7004?
Corporate Excise Taxpayers Any company eligible to file Form M-990T may use this application
The extension process is now automated so that all corporate excise to request either an automatic eight-month extension of time to file
taxpayers will be given an extension of time to file their tax returns their return or an extension of time to file for more than eight months.
as long as certain payment requirements are met. Generally, to Form M-990T-7004 also acts as the required tentative return.
meet these payment requirements, corporate excise taxpayers must
have paid the greater of (1) 50% of the total amount of tax ultimately When Should Form M-990T-7004 Be Filed?
due or (2) the minimum corporate excise by the original due date for This application must be filed on or before the 15th day of the third
filing the return. Consistent with current rules, taxpayers meeting month after the close of the taxable year, calendar or fiscal.
these payment requirements will be given a seven-month extension
in the case of corporate excise taxpayers filing combined reports Must a Payment Be Submitted with This Form?
and a six-month extension in the case of other corporate excise tax- Yes. The full payment of tax reasonably estimated to be due must
payers. However, taxpayers filing unrelated business income tax accompany this form. If at least 50% of the tax due for the taxable
returns will be given an eight-month extension. See TIR 15-15 for year is not paid, the extension is null and void.
more information.
Will Interest and Penalties Be Due?
Why Is an Eight-Month Extension Allowed? An extension of time to file a corporation tax return does not extend
In lieu of a six-month automatic extension request, an eight-month the due date for payment of the tax. Interest will be charged on any
automatic extension for exempt organizations filing Form M-990T is tax not paid on or before the original due date. Any tax not paid within
allowed. The eight-month extension will make Form M-990T and the extended period is subject to a penalty of 1% per month, up to a
U.S. Form 990-T due on the same date. For further information, see maximum of 25%, from the extended due date.
Department Directive 07-3, Notice to Corporate UBIT Filers.

DETACH HERE

Form M-990T-7004 Application for UBIT Extension — 2015 Massachusetts
Department of Revenue
Federal Identification number Is the corporation incorporated in Massachusetts? Period end date Amount enclosed
Yes No
Tax type ID type Vendor code
036 Voucher type 004
Business name 18 Type of extension being applied for

Mailing address a. Automatic eight-month b. Extension until: State Zip
City/Town

Sign here. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.

Signature of officer or agent Signature of paid preparer Date

Employer Identification number of paid preparer Social Security number or PTIN of paid preparer

How Long Is the Period of Extension?
An automatic eight-month extension is granted upon the proper filing
of this form. An extension for a period longer than eight months may
be granted if good cause exists; it requires the written approval of the
Commissioner before it becomes effective. The Commissioner may
terminate this extension at any time by mailing a notice of termination
to the corporation or to the person who requested the extension for
the corporation. The notice will be mailed at least 10 days prior to the
termination date designated in the notice.

Who May Sign?
Form M-990T-7004 must be signed by the treasurer or assistant trea-
surer of the company or by a person authorized by the company to do
so. An application signed by an unauthorized person will be consid-
ered null and void. If a return is filed after the original due date based
on a void extension, interest and penalties will be assessed back to
the original due date.

Keep this worksheet with your records. Do not submit it with Form
M-990T-7004. Mail the completed application to: Massachusetts
Department of Revenue, PO Box 7025, Boston, MA 02204.