Form 973 - Corporation Claim For Deduction For Consent Dividends

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Corporation Claim for Deduction
973
Form
for Consent Dividends
OMB No. 1545-0044
(Rev. December 2003)
(Under Section 561 of the Internal Revenue Code)
Department of the Treasury
For tax year beginning
, 20
, and ending
, 20
.
Internal Revenue Service
Name of corporation
Employer identification number
Number of shares
Number of shares
Actual distributions per
Class of stock
outstanding on first
outstanding on last
Description of dividend rights
share 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.
Cat. No. 17059P
Form
(Rev. 12-2003)

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