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e-file Form 15397 Application for Extension of Time to Furnish Recipient Statements

INSTRUCTIONS: No usernames or passwords required. Prepare your form and click the validate button below. ALL PARTS must display Complete. The AutoFill feature is optional. Once your forms are submitted, copies of the completed forms will NOT be available for later retrieval. Ensure you download and retain a copy for your records.
Taxable year:*
Taxpayer identification number (TIN):*
  EIN
  SSN
Business name:*
First and Last name:*
If you have a foreign address, click here:
Address:*
City, State and Zip code:*
Foreign province, postal code and country:
Contact email address:
Forms for which an extension is requested:*
  1042-S
  1095-B, 1095-C
  1097, 1098, 1099, 3921, 3922, W-2G
  5498
  5498-ESA
  5498-QA
  5498-SA
  5498-TA
  W-2
Describe your need for an extension to furnish recipient(s) statements of information returns
Name:*
Title:*
Date:*
Best daytime phone:*
Signature PIN (5 digits):*
Authorized signature:*
 
Your cost: $0.00 
PERJURY STATEMENT: Under penalties of perjury, I declare that I have examined this application and accompanying documents and statements, and to the best of my knowledge and belief, they are true, correct, and complete. By entering my electronic signature PIN and submitting this application, I affirm that I am authorized to sign on behalf of the filer. I consent to allow Tax Me, LLC. to electronically file this Form 15397 with the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission and (b) information regarding the processing of this application. ACKNOWLEDGEMENT: I certify that: a) I understand that I may be subject to penalties if I submit fraudulent information. b) I understand that TaxMe may prevent me from using this service if TaxMe determines or suspects there has been misuse of this system. c) I am aware that any person who knowingly and willingly makes any representation to falsely obtain information from TaxMe records and/or intends to deceive TaxMe as to the true identity of an individual could be punished by a fine or imprisonment, or both. d) I understand that once this application is submitted, a copy of the completed Form 15397 will not be available for later retrieval, and I have downloaded and retained a copy for my records.      I agree