Form 851 - Affiliations Schedule For Tax Year Ending - 2016 Page 3
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Form 851 (Rev. 10-2016)
Page
Part IV
Additional Stock Information (see instructions)
1
During the tax year, did the corporation have more than one class of stock outstanding? .
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Yes
No
If “Yes,” enter the name of the corporation and list and describe each class of stock.
Corp.
Name of corporation
Class of stock
No.
2 During the tax year, was there any member of the consolidated group that reaffiliated within 60 months of
disaffiliation?
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Yes
No
If “Yes,” enter the name of the corporation(s) and explain the circumstances.
Corp.
Name of corporation
Explanation
No.
3 During the tax year, was there any arrangement in existence by which one or more persons that were not
members of the affiliated group could acquire any stock, or acquire any voting power without acquiring
stock, in the corporation, other than a de minimis amount, from the corporation or another member of the
affiliated group? .
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Yes
No
If “Yes,” enter the name of the corporation and see the instructions for the percentages to enter in columns
(a), (b), and (c).
(b)
(c)
(a)
Corp.
Percentage of
Name of corporation
Percentage of
No.
Percentage of value
outstanding voting
voting power
stock
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%
Corp.
(d) Provide a description of any arrangement.
No.
851
Form
(Rev. 10-2016)
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