Form 5r - Wisconsin Revocation Of Election By An S Corporation Not To Be A Tax-Option Corporation

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Form
5R
Mail this form to:
Wisconsin
Wisconsin Department
Revocation of Election by an S Corporation
of Revenue
PO Box 8908
Not to Be a Tax-Option Corporation
Madison WI 53708-8908
Corporation Name
A Federal Employer ID Number
Number and Street
Suite Number
B State of Incorporation
and
Year
ZIP Code (+ 4 digit suffix if known) C Number of Shareholders
State
D Number of Shares Issued and
City
Outstanding
E Revocation is to be effective for taxable year beginning:
M
M
D
D
Y
Y
Y
Y
The undersigned, owning in total more than 50% of the issued and outstanding shares of the above S corporation on the
date of this revocation, consent to have the corporation be treated as a tax-option corporation for Wisconsin franchise or in-
come tax purposes. This revocation will be effective for the taxable year indicated above. Each shareholder, in signing this
revocation, declares that the information with respect to his or her name, address, federal identifying number, and stock
ownership has been examined and, to the best of the shareholder’s knowledge and belief, is true, correct, and complete.
Federal
Stock Owned
Name and Address of Shareholder
Identifying
Shareholder’s Signature
Number of
Date
Number
Shares
Acquired
I, the undersigned authorized officer of the corporation for which this revocation is made, have personally examined this revocation, includ-
ing any accompanying schedules and statements, and declare that it is, to the best of my knowledge and belief, true, correct, and complete.
Signature
Title
Date
IC-042

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