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Form F-851 - Corporate Income/franchise And Emergency Excise Tax Affiliations Schedule Template - Florida Department Of Revenue

F-851

Corporate Income/Franchise

R. 01/07

Attach this schedule

and Emergency Excise Tax

to Form F-1120

Affiliations Schedule

For Taxable Year beginning ____________ , ____________ , and ending ____________ , ____________ .

Who must file Form F-851?

This form must be filed by the parent corporation for consolidated tax returns. Federal Form 851 may be substituted if the federal and

Florida consolidated groups are identical. Report changes to the consolidated group in Part II, on the reverse side of this form.

PART I

Florida Common Parent Corporation

FEIN

Address (Number, Street, City, State, and ZIP)

No.

Name and Address of Corporation

% of

FEIN

Ownership

Common parent corporation:

Subsidiary corporation:

Statement of Affiliation — Do the above named corporations comprise an affiliated group of

■

Yes

■

corporations as described in s. 1504(a) of the I.R.C.?

Remarks:

Under penalties of perjury, I declare that the above information and statements have been examined by me and that they are

true, correct, and complete to the best of my knowledge and belief, for the taxable year as stated above.

__________________________________

__________________________________________

Date

Signature of Officer

__________________________________

__________________________________________

Title

Phone Number

Form F-851 - Corporate Income/franchise And Emergency Excise Tax Affiliations Schedule Template - Florida Department Of Revenue