Mail this application and remit payment (electronically, if required) to:
Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
7004N
FORM
8-021-1968 Rev. 12-2021
Supersedes 8-021-1968 Rev. 12-2020
Application for Automatic Extension of Time
to File Nebraska Corporation, Fiduciary, or Partnership Return
Taxable year beginning , and ending ,
1 Tentative income tax liability for taxable period before any applicable credits ................... 1
2 Premium tax credit ................................................................ 2
3 Community Development Assistance Act credit ......................................... 3
4 Form 3800N nonrefundable credits ................................................... 4
5 Total nonrefundable credits (total of lines 2 through 4)..................................... 5
6 Tentative income tax liability after nonrefundable credits. Subtract line 5 from line 1 (if the line 5
amount is more than the line 1 amount, enter -0-) ........................................ 6
7 Form 3800N refundable credits ...................................................... 7
8 Estimated income tax payments ..................................................... 8
9 Other payments or credits, including any Beginning Farmer credit, employer’s credit for expenses
incurred for TANF (ADC) recipients, School Readiness Tax Credit for providers, and Property Tax
Incentive Act credit ................................................................ 9
10 Total prior payments and credits (total of lines 7 through 9)................................. 10
11 Tentative tax payment (line 6 minus line 10) ............................................ 11
Check this box if your payment is being made electronically.
If the corporation is a member of a unitary group of corporations filing a combined return, complete the following section.
Name and Address of Each Member of the Unitary Group
ID Numbers
Nebraska
Federal
Under penalties of perjury, I declare that I have been authorized to make this application, and that to the best of my knowledge and belief, the
statements made above are correct and complete.
Name Doing Business As (dba)
Legal Name
Street or Other Mailing Address
City State Zip Code Federal ID Number Nebraska ID Number
Tentative Tax Payment Calculation
• Entities filing a fiduciary or partnership return need not complete lines 1 through 10 below. A fiduciary or partnership must complete line 11.
Automatic 6-Month Extension
• Check one of the boxes below if filing Federal Forms 1041, 1041-QFT, 1041-N, or 1065.
Nebraska Fiduciary Income Tax Return, Form 1041N Nebraska Return of Partnership Income, Form 1065N
Automatic 7-Month Extension
• Check all appropriate boxes if filing Nebraska Forms 1120N or 1120-SN.
Automatic seven-month filing extension from the Extension in addition to the federal extension up to a
original due date. maximum of seven months from the original due date.
Attach a copy of the Federal Form 7004 filed with the
Internal Revenue Service.
Is the corporation organized as an exempt organization? YES NO
Is the corporation a cooperative described in IRC section 6072(d)? YES NO
Is the corporation an S corporation? YES NO
Is the corporation a foreign corporation with no US offices? YES NO
Authorized Signature Date Email Address
Title
Daytime Phone Number
sign
here
RESET
PRINT
Who May File. A corporation (C corporation and S corporation), duciary, partnership, or limited liability company
making a tentative tax payment, and/or wanting more time to le a Nebraska tax return, must le a Nebraska
Application for Extension of Time, Form 7004N. The Form 7004N must be led even if a tentative income tax
payment is madeelectronically.
If you have led for a federal extension and are not making a tentative income tax payment to Nebraska, you do
not need to complete this application. When your Nebraska income tax return is led, you must attach a copy of the
Federal Form 7004 led with the IRS, or a copy of the approved federal extension. If a federal extension of time has
been granted, the ling date for Forms 1120N, 1120-SN, and 1065N is automatically extended for the same period.
If a federal extension of time has been granted to an estate or trust, the ling date for Form 1041N is automatically
extended for six months.
Corporations. When a federal extension of time has been granted and additional time is necessary to le a Nebraska
corporation income tax return, le Form 7004N on or before the date the federal extension expires. Attach a copy of
the Federal Form 7004 led with the IRS, or a copy of the approved federal extension. A maximum of a seven-month
extension beyond the original due date of the corporation income tax return is allowed for Nebraska.
Partnerships, Estates, and Trusts. Nebraska will only allow partnerships an extension of time up to the maximum
number of months provided by the IRS. Nebraska will allow estates and trusts an extension of up to six months. No
additional Nebraska extension will be granted.
When to File. Form 7004N must be led on or before the due date of the original return. Corporations may also le
Form 7004N on or before the date that a federal extension expires.
Where to File. Mail Form 7004N to the Nebraska Department of Revenue, PO Box 94818, Lincoln, Nebraska
68509-4818.
Amount of Payment. Payment of the amount shown on line 11 must be remitted either with this form or electronically
using one of the electronic payment options identied below.
Mandates of Electronic Payment. Some entities are required to make their payments (tax, penalty, and interest)
electronically. For mandate purposes, all of the electronic payment options listed below satisfy the mandate
requirement. All entities are encouraged to make their payments electronically.
Electronic Payment Options
Nebraska e-pay. Nebraska e-pay is the Nebraska Department of Revenue's (DOR's) web-based electronic
payment system. You enter your payment and bank account information, and choose a date (up to a year in
advance) to have your account debited. You will receive an email conrmation for each payment scheduled.
ACH Credit. You (or your bank) create an electronic le in the appropriate ACH le format. It is submitted to
the Federal Reserve and instructs your bank to “credit” the state’s bank account.
Nebraska Tele-pay. Nebraska Tele-pay is DOR's phone-based electronic payment system. Call800-232-0057,
enter your payment and bank account information, and choose a date (up to a year in advance) to have your
account debited. You will receive a conrmation number at the end of your call.
Credit Card (Corporations only). Secure credit card payments can be initiated through ACI Payments, Inc.
at acipayonline.com or via phone at 800-272-9829. Eligible credit cards include American Express, Discover,
MasterCard, and VISA. A convenience fee (2.35% of the payment, $1 minimum) is charged to the card you use.
This fee is paid to the credit card vendor, not the state, and will appear on your credit card statement separately
from the payment made to DOR. At the end of your transaction, you will be given a conrmation number. Keep
this number for your records. [If you are making your credit card payment by phone, you will need to provide
the Nebraska Jurisdiction Code, which is 3700.]
Check or Money Order. If you are not using one of the electronic payment options described above, include a check
or money order payable to the “Nebraska Department of Revenue.” Checks written to DOR may be presented for
paymentelectronically.
Corporate Unitary Group. Members of a unitary group ling a single return using the combined income approach
should only request one extension for the entire group. The name, address, Federal ID number, and Nebraska ID
number of each corporation included in the combined return must be listed on Form 7004N.
Terminating the Extension. DOR may, at any time, terminate a C corporation’s extension of time by mailing the
taxpayer a notice of termination and allowing ten days from the date of the termination notice to le the Nebraska
corporate return.
Taxpayer Notification. DOR will notify the applicant if this request for extension is denied. The notice will be sent
to the address entered on Form 7004N. No notice will be sent with respect to approved applications for an extension of
time to le a return.
Signatures. This application must be signed by a corporate ofcer, duciary, partner, member, a person currently
enrolled to practice before the IRS, or an attorney or certied public accountant qualied to practice before the IRS. If
the taxpayer authorizes any other person to sign this application, there must be a power of attorney on le with DOR.
Email. By entering an email address, the taxpayer acknowledges that DOR may contact the taxpayer by email.
The taxpayer accepts any risk to condentiality associated with this method of communication. DOR will send
all condential information by secure email or the State of Nebraska’s le share system. If you do not wish to be
contacted by email, write “Opt Out” on the line labeled “email address.”
Instructions