Form 1139 - Corporation Application For Tentative Refund
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11139
Corporation Application for Tentative Refund
Form
Information about Form 1139 and its separate instructions is at
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OMB No. 1545-0123
(Rev. November 2014)
Do not file with the corporation’s income tax return—file separately.
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Department of the Treasury
Keep a copy of this application for your records.
Internal Revenue Service
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Name
Employer identification number
Number, street, and room or suite no. If a P.O. box, see instructions.
Date of incorporation
City or town, state, and ZIP code
Daytime phone number
c Unused general
1
Reason(s) for filing.
a Net operating loss (NOL) .
business credit
.
▶
See instructions—
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$
$
attach computation
b Net capital loss
d Other
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$
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$
a Tax year ended
b Date tax return filed c Service center where filed
2
Return for year of loss, unused credit, or
overpayment under section 1341(b)(1)
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If this application is for an unused credit created by another carryback, enter ending date for the tax year of the first carryback
3
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4
Did a loss result in the release of a foreign tax credit, or is the corporation carrying back a general business credit that
was released because of the release of a foreign tax credit (see instructions)? If “Yes,” the corporation must file an
amended return to carry back the released credits
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Yes
No
Yes
No
5a
Was a consolidated return filed for any carryback year or did the corporation join a consolidated group (see instructions)?
If “Yes,” enter the tax year ending date and the name of the common parent and its EIN, if different from above (see instructions)
b
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Yes
No
6a
If Form 1138 has been filed, was an extension of time granted for filing the return for the tax year of the NOL?
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b
If “Yes,” enter the date to which extension was granted
c Enter the date Form 1138 was filed .
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d
Unpaid tax for which Form 1138 is in effect
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$
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If the corporation changed its accounting period, enter the date permission to change was granted .
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7
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If this is an application for a dissolved corporation, enter date of dissolution .
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8
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Yes
No
9
Has the corporation filed a petition in Tax Court for the year or years to which the carryback is to be applied? .
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Is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be
10
disclosed? If Yes, attach Form 8886
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Yes
No
Computation of Decrease in Tax
preceding
preceding
preceding
See instructions.
tax year ended
tax year ended
tax year ended
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Note: If only filing for an unused general business
(a) Before
(b) After
(c) Before
(d) After
(e) Before
(f) After
credit (line 1c), skip lines 11 through 15.
carryback
carryback
carryback
carryback
carryback
carryback
11
Taxable income from tax return .
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12
Capital loss carryback (see instructions)
13
Subtract line 12 from line 11 .
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14
NOL deduction (see instructions)
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15
Taxable income. Subtract line 14 from line 13
16
Income tax
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17
Alternative minimum tax .
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18
Add lines 16 and 17 .
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19
General business credit (see instructions)
20
Other credits (see instructions) .
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21
Total credits. Add lines 19 and 20 .
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22
Subtract line 21 from line 18 .
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23
Personal holding company tax (Sch. PH (Form 1120))
24
Other taxes (see instructions)
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25
Total tax liability. Add lines 22 through 24
Enter
amount
from
“After
carryback”
26
column on line 25 for each year .
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27
Decrease in tax. Subtract line 26 from line 25
28
Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)
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Sign
Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Here
Signature of officer
Date
Title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
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Firm's address
Phone no.
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1139
For Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 11-2014)
Cat. No. 11170F
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