Arizona Small Business Income Tax Extension Payment

Small Business Income Tax Extension Payment
Arizona Form 204
DO NOT STAPLE ANY ITEMS TO THE RETURN.

Arizona Form

204-SBI

FOR
CALENDAR YEAR

Extension Payment

Small Business Income Tax Returns Only

2023

For the calendar year 2023 or fiscal year beginning M M D D 2 0 2 3 and ending M M D D 2 0 Y Y .

1
1
2
3
94

Your First Name and Middle Initial

Last Name

Spouse’s First Name and Middle Initial (if filing joint)

Last Name

Current Home Address - number and street, rural route
City, Town or Post Office

Apt. No.
State

ZIP Code

Enter
your
SSN(s).

66

Your Social Security Number

Spouse’s Social Security No.

95. Filing Status. Must be the same as Form 140-SBI, 140NR-SBI or 140PY-SBI
95a
Married filing joint return
95c
Head of Household
95b
Married filing separate return 95d
Single

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

88

Your daytime phone number (include area code):

Check only one box:

 Full-Year Resident - Form 140-SBI	
 Part-Year Resident - Form 140PY-SBI
	 Nonresident - Form 140NR-SBI

81 PM

80 RCVD

Complete this form only if you are making an extension payment for your Small Business Income Tax Return.
If you are not making an extension tax payment for your Small Business Income tax return, do not complete this form. You must
complete Form 204, Application for Filing Extension, on or before the original due date, to request an automatic 6-month extension to
file your small business income tax return.
Filing Form 204 to request an automatic 6-month extension for your income tax return (Form 140, 140PY or 140NR) will also provide an
automatic 6-month extension to file your Small Business Income tax return (Form 140-SBI, 140PY-SBI or Form 140NR-SBI).
	1	 Small Business Income tax liability for 2023. You may estimate this amount................................................. 1
00
	2	 Arizona estimated tax payments for 2023......................................................................	 2
00
	 3 Credits you will claim on your 2023 return. See Arizona Form 301-SBI for a list of credits. 3
00
	4	 Add lines 2 and 3........................................................................................................... 4
00
	5	 Balance of Tax: Subtract line 4 from line 1..................................................................................................... 	 5
00
	6	 Enter amount of extension payment enclosed........................................................PAYMENT ENCLOSED 6
00
		
	 • Make check payable to Arizona Department of Revenue; write your SSN, Form 204-SBI and tax year on your payment.
	 •	 Include your payment with this form.
	

•	 IMPORTANT: If you are filing under an extension using a federal extension or if you filed Form 204 but are making
an Arizona extension payment by credit card or electronic payment, do not mail Form 204-SBI to us. We will apply
your extension tax payment to your account.
•	 If you are sending a payment with this form, mail to Arizona Department of Revenue,
PO Box 29085, Phoenix, AZ 85038-9085.

Print Form
ADOR 11402 (23)