2017FORM 1100-EXT DELAWARE DIVISION OF REVENUE

CORPORATION INCOME TAX REQUEST FOR EXTENSIONREV CODE0042 25 05

Extension ToFederal Identification Number Calendar or Fiscal Year Ending Due on or Before

Name of Corporation

Number, street and room or suite number or P.O. Box

City State Zip Code

1. Income Tax Liability (8.7% x Total Delaware Apportioned + Non-ApportionedIncome) $ 00

$

$

$

00

00

00

2. Tentative Tax Due (100% of Line 1)

3. Less Amount of Tentative Tax Previously Paid

4. Balance Due (Line 2 minus Line 3)

INSTRUCTIONS FOR FILING A REQUEST FOR EXTENSIONAn extension of six months for filing the annual Delaware Corporation Income Tax return may be made by filing Form1100-EXT on or before the due date of the original return. Please note that timely filed extensions extend the period oftime for filing a final return but DO NOT extend the period of time for making payment. Payment of the anticipatedliability must be made with the extension request. Extensions without payment of the anticipated liability willnot be granted.

Please use the schedule below to determine the due date of the extension request and the period the Delawarecorporate return is extended to and place this information in the appropriate boxes above:

CONSOLIDATED DELAWARE CORPORATE INCOME TAX RETURNSConsolidated Corporate Income Tax returns are not permitted under Delaware Law. Each corporation which is amember of a consolidated group must file separate Delaware Corporate Income Tax returns and Extensions as ifa separate Federal Income Tax return was filed.

Authorized Signature Date Telephone Number

Mail to: Delaware Division of Revenue, P.O. Box 8751, Wilmington, DE 19899-8751 or FAX (302) 577-8203

(Revised 02/23/18) *DF11514019999*DF11514019999

Tax Year Ending Extended To:12/31/201701/31/201802/28/201803/31/201804/30/201805/31/201806/30/201807/31/201808/31/201809/30/201810/31/201811/30/2018

Due on or Before 04/17/201805/15/201806/15/201807/16/201808/15/201809/17/201810/15/201811/15/201812/17/201801/15/201902/15/201903/15/2019

10/15/201811/15/201812/17/201801/15/201902/15/201903/15/201904/15/201905/15/201906/17/201907/15/201908/15/201909/16/2019