Form 1128 - Application To Adopt, Change, Or Retain A Tax Year Page 2
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Form 1128 (Rev. 10-2014)
Page
Part II
Automatic Approval Request (see instructions)
• Identify the revenue procedure under which this automatic approval request is filed
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Section A—Corporations (Other Than S Corporations or Personal Service Corporations) (Rev. Proc. 2006-45, or its successor)
Yes No
1
Is the applicant a corporation (including a homeowners association (section 528)) that is requesting a change in
tax year and is allowed to use the automatic approval rules under section 4 of Rev. Proc. 2006-45 (or its
successor)? (see instructions) .
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2
Does the corporation intend to elect to be an S corporation for the tax year immediately following the short period?
If “Yes” and the corporation is electing to change to a permitted tax year, file Form 1128 as an attachment to Form
2553.
3
Is the applicant a corporation requesting a concurrent change for a CFC, FSC or IC-DISC? (see instructions) .
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Section B—Partnerships, S Corporations, Personal Service Corporations (PSCs), and Trusts (Rev. Proc. 2006-46, or
its successor)
4
Is the applicant a partnership, S corporation, PSC, or trust that is requesting a tax year and is allowed to use the
automatic approval rules under section 4 of Rev. Proc. 2006-46 (or its successor)? (see instructions)
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5
Is the partnership, S corporation, PSC, or trust requesting to change to its required tax year or a partnership, S
corporation, or PSC that wants to change to a 52-53 week tax year ending with reference to such tax year? .
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6
Is the partnership, S corporation, or PSC (other than a member of a tiered structure) requesting a tax year that
coincides with its natural business year described in section 4.01(2) of Rev. Proc. 2006-46 (or its successor)?
Attach a statement showing gross receipts for the most recent 47 months. (See instructions for information
required to be submitted)
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Is the S corporation requesting an ownership tax year? (see instructions) .
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Is the applicant a partnership requesting a concurrent change pursuant to section 6.09 of Rev. Proc. 2006-45
(or its successor) or section 5.04(8) of Rev. Proc. 2002-39 (or its successor)? (see instructions)
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Section C—Individuals (Rev. Proc. 2003-62, or its successor) (see instructions)
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Is the applicant an individual requesting a change from a fiscal year to a calendar year? .
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Section D—Tax-Exempt Organizations (Rev. Proc. 76-10 or 85-58) (see instructions)
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Is the applicant a tax-exempt organization requesting a change?
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Part III
Ruling Request (All applicants requesting a ruling must complete Section A and any other section that
applies to the entity. See instructions.) (Rev. Proc. 2002-39, or its successor)
Yes No
Section A—General Information
1
Is the applicant a partnership, S corporation, personal service corporation, or trust that is under examination by
the IRS, before an appeals office, or a Federal court?
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If “Yes,” see the instructions for information that must be included on an attached explanation.
2
Has the applicant changed its annual accounting period at any time within the most recent 48-month period
ending with the last month of the requested tax year? .
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If “Yes” and a letter ruling was issued granting approval to make the change, attach a copy of the letter ruling, or if
not available, an explanation including the date approval was granted. If a letter ruling was not issued, indicate
when and explain how the change was implemented.
3
Within the most recent 48-month period, has any accounting period application been withdrawn, not perfected,
denied, or not implemented?
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If “Yes,” attach an explanation.
4 a Is the applicant requesting to establish a business purpose under section 5.02(1) of Rev. Proc. 2002-39 (or its
successor)? .
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If “Yes,” attach an explanation of the legal basis supporting the requested tax year (see instructions).
b If your business purpose is based on one of the natural business year tests under section 5.03, check the
applicable box.
Annual business cycle test
Seasonal business test
25-percent gross receipts test
Attach a statement showing gross receipts from sales and services (and inventory cost if applicable) for the test
period. (see instructions)
5
Enter the taxable income or (loss) for the 3 tax years immediately preceding the year of change and for the short
period. If necessary, estimate the amount for the short period.
$
$
Short period
First preceding year
$
$
Second preceding year
Third preceding year
Note: Individuals, enter adjusted gross income. Partnerships and S corporations, enter ordinary income. Section
501(c) organizations, enter unrelated business taxable income. Estates, enter adjusted total income. All other
applicants, enter taxable income before net operating loss deduction and special deductions.
1128
Form
(Rev. 10-2014)
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