Form 1128 - Application To Adopt, Change, Or Retain A Tax Year Page 4
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Form 1128 (Rev. 10-2014)
Page
Section C—S Corporations (see instructions)
19
Enter the date of the S corporation election.
Yes No
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20
Is any shareholder applying for a corresponding change in tax year?
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If “Yes,” each shareholder requesting a corresponding change in tax year must file a separate Form 1128 to get
advance approval to change its tax year.
21
If the corporation is using a tax year other than the required tax year, indicate how it obtained its tax year.
)
Grandfathered (attach copy of letter ruling)
Section 444 election (date of election
Letter ruling (date of letter ruling
(attach copy))
22
Attach a statement providing each shareholder’s name, type of shareholder (individual, estate, qualified
subchapter S Trust, electing small business trust, other trust, or exempt organization), address, identifying
number, tax year, percentage of ownership, and the amount of income each shareholder received from the S
corporation for the first preceding year and for the short period.
Section D—Partnerships (see instructions)
23
Yes No
Enter the date the partnership’s business began.
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24
Is any partner applying for a corresponding change in tax year? .
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25
Attach a statement providing each partner’s name, type of partner (individual, partnership, estate, trust,
corporation, S corporation, IC-DISC, etc.), address, identifying number, tax year, and the percentage of interest in
capital and profits.
26
Is any partner a shareholder of a PSC as defined in Regulations section 1.441-3(c)? .
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If “Yes,” attach a statement providing the name, address, identifiying number, tax year, percentage of interest in
capital and profits, and the amount of income received from each PSC for the first preceding year and for the
short period.
27
If the partnership is using a tax year other than the required tax year, indicate how it obtained its tax year.
)
Grandfathered (attach copy of letter ruling)
Section 444 election (date of election
Letter ruling (date of letter ruling
(attach copy))
Section E—Controlled Foreign Corporations (CFC)
28
Attach a statement for each U.S. shareholder (as defined in section 951(b)) providing the name, address,
identifying number, tax year, percentage of total value and percentage of total voting power, and the amount of
income included in gross income under section 951 for the 3 tax years immediately before the short period and
for the short period.
Section F—Tax-Exempt Organizations
29
Yes No
Type of organization:
Corporation
Trust
Other (specify)
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30
Date of organization.
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31
Code section under which the organization is exempt.
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32
Is the organization required to file an annual return on Form 990, 1120-C, 990-PF, 990-T, 1120-H, or 1120-POL?
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Enter the date the tax exemption was granted.
33
. Attach a copy of the letter ruling granting
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exemption. If a copy of the letter ruling is not available, attach an explanation.
34
If the organization is a private foundation, is the foundation terminating its status under section 507?
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Section G—Estates
Enter the date the estate was created.
35
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36 a Attach a statement providing the name, identifying number, address, and tax year of each beneficiary and each person who is
an interested party of any portion of the estate.
b Based on the adjusted total income of the estate entered in Part III, Section A, line 5, attach a statement showing the
distribution deduction and the taxable amounts distributed to each beneficiary for the 2 tax years immediately before the short
period and for the short period.
Section H—Passive Foreign Investment Companies
37
If the applicant is a passive foreign investment company, attach a statement providing each U.S. shareholder’s name, address,
identifying number, and percentage of interest owned.
1128
Form
(Rev. 10-2014)
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