An integrated circuit containing an extended drain MOS transistor which has a drift layer, an upper RESURF layer over and contacting an upper surface of the drift layer, and a buried drain extension below the drift layer which is electrically connected to the drift layer at the drain end and separated from the drift layer at the channel end. A lower RESURF layer may be formed between the drift layer and the buried drain extension at the channel end. Any of the upper RESURF layer, the drift layer, the lower RESURF layer and the buried drain extension may have a graded doping density from the drain end to the channel end. A process of forming an integrated circuit containing an extended drain MOS transistor which has the drift layer, the upper RESURF layer, and the buried drain extension.