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Estimated Volume to be Filed

. . .

Form 1041

. . .

Form 1065

Returns

. . . .

. . . . .

Form 5500-C

Form 5500-R

Don't know at this time.

K-1 (1041)

. . .

K-1 (1065)

. . .

Schedules K-1

Not applicable.

Don't know at this time.

Under penalties of perjury, I declare that I have examined this application and any accompanying information, and to the best of my

knowledge and belief it is true, correct, and complete. This firm and its employees will comply with all the provisions of the procedure

for magnetic media filing of Forms 1041, 1065, or 5500-C/R as applicable. The firm understand that if it is sold or its organizational

Applicant

structure is changed, acceptance for participation is not transferable, a new application must be filed. The firm further understands

Agreement

that noncompliance will result in the firm no longer being allowed to participate in the program. I am authorized to make and sign this

statement on behalf of the firm.

10. Name and title of person responsible for filing this application

(Please print.)

12. Date

11. Signature of person responsible for this application

Paperwork Reduction Act Notice

We ask for this information to carry out the Internal Revenue laws of the United States. We need it to process your application for electronic/magnetic media

filing of Forms 1041, 1065, and 5500-C/R. You must give us this information if you wish to participate in the electronic/magnetic media filing program for these

forms.

The time needed to complete this form will vary depending upon individual circumstances. The estimated average time is 18 minutes. If you have comments

concerning the accuracy of this time estimate or suggestions for making this form more simple, we would be happy from you. You can write to both the Internal

Revenue Service, Washington, DC 20224, Attention: IRS Reports Clearance Officer T:FP; and Office of Management and Budget, Paperwork Reduction

Project (1545-1079), Washington, DC 20503. DO NOT send this form to either of these offices. Instead, see the instructions below on where to file.

Instructions

Purpose of form.—File Form 9041 if you would like to take part in the electronic/magnetic media filing program for Forms 1041, 1065, and 5500-C/R. Only

those who did not participate in last year's electronic/magnetic media filing program need apply, and those for whom information in item 1 has changed since we

last contacted you.

When to file.—To ensure complete and timely review of your application, file Form 9041 at least 30 calendar days before the end of the accounting period for

which the entity files. IRS uses the postmark date on the envelope to determine whether the application was filed timely.

Where to file.—

Send the completed Form 9041

for Forms 1041 to:

for Forms 1065 and 5500-C/R to:

Internal Revenue Service Center

Internal Revenue Service

Philadelphia Service Center

Andover Service Center

Attn: DP 115

Attn: EFU-Stop 983

11601 Roosevelt Blvd

P.O. Box 4050

Philadelphia, PA 19155

Woburn, MA 01899-9741

Line 1a—Enter the name as shown on your tax return.

Line 1c—If you have both a post office box and street address, enter both addresses for the firm's main office. We need both addresses in case we need to

send information to you by overnight mail.

Line 1d and 1h—If this information changes, please notify the IRS Service Center where you originally filed Form 9041.

Line 3—Electronic filer identification numbers (EFINs) were assigned by the Andover Service Center in previous years for electronic/magnetic media Forms

1041, 1065, and 5500-C/R filed there. Magnetic media transmission identification numbers (MTINs) were assigned by the Philadelphia Service Center for tax

year 1989 Forms 1041 that were filed on magnetic tape.

Line 5—Complete this section if you file Form 5500-C/R, and you are a plan administrator. Please enter the plan administrator information as shown on the

Form 5500-C/R.

Line 6—Complete this section if you would like your name and address given to vendors of services related to electronic/magnetic media filing. This will give

you an opportunity to receive electronic/magnetic media filing information from vendors who either have applied or have participated in the program.

Line 7—If this information changes, please notify the appropriate service; i.e., Andover Service Center or Philadelphia Service Center. If you do not know what

software company or transmitter you will use, or if you will use your own software or communication equipment, please indicate this in the space provided.

9041

Form

(Rev. 10-90)

U.S. GOVERNMENT PRINTING OFFICE: 1991 517-015/27929