Form 973 - Corporation Claim For Deduction For Consent Dividends

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973
Corporation Claim for Deduction
Form
for Consent Dividends
(Rev. November 2016)
OMB No. 1545-0123
(Under Section 561 of the Internal Revenue Code)
Information about Form 973 and its instructions is at
▶
Department of the Treasury
For tax year beginning
, 20
, and ending
, 20
.
Internal Revenue Service
Employer identification number
Name of corporation
Number of shares
Number of shares
Actual distributions per share
Class of stock
outstanding on first
outstanding on last
Description of dividend rights
made in tax year*
day of tax year
day of tax year
* If a distribution was not made on all shares of any class, describe any unequal treatment:
Describe any other changes in outstanding stock during the tax year:
(Use more sheets if necessary.)
973
For Paperwork Reduction Act Notice, see back of form.
Form
(Rev. 11-2016)
Cat. No. 17059P

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