Form 3115 - Application For Change In Accounting Method Page 2
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Form 3115 (Rev. 12-2009)
Page
Information For All Requests (continued)
Part II
Yes No
4 c Is the method of accounting the applicant is requesting to change an issue pending (with respect to either the
applicant or any present or former consolidated group in which the applicant was a member during the applicable
tax year(s)) for any tax year under examination (see instructions)?
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d Is the request to change the method of accounting being filed under the procedures requiring that the operating
division director consent to the filing of the request (see instructions)? .
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If “Yes,” attach the consent statement from the director.
e Is the request to change the method of accounting being filed under the 90-day or 120-day window period? .
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If “Yes,” check the box for the applicable window period and attach the required statement (see instructions).
90 day
120 day:
Date examination ended
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If you answered “Yes” to line 4a, enter the name and telephone number of the examining agent and the tax
year(s) under examination.
Name
Telephone number
Tax year(s)
g Has a copy of this Form 3115 been provided to the examining agent identified on line 4f?
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5 a Does the applicant (or any present or former consolidated group in which the applicant was a member during the
applicable tax year(s)) have any Federal income tax return(s) before Appeals and/or a Federal court?
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Appeals officer and/or
counsel for the government,
If “Yes,” enter the name of the (check the box)
telephone number, and the tax year(s) before Appeals and/or a Federal court.
Name
Telephone number
Tax year(s)
b Has a copy of this Form 3115 been provided to the Appeals officer and/or counsel for the government identified
on line 5a?
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c Is the method of accounting the applicant is requesting to change an issue under consideration by Appeals and/or
a Federal court (for either the applicant or any present or former consolidated group in which the applicant was a
member for the tax year(s) the applicant was a member) (see instructions)? .
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If “Yes,” attach an explanation.
If the applicant answered “Yes” to line 4a and/or 5a with respect to any present or former consolidated group,
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attach a statement that provides each parent corporation’s (a) name, (b) identification number, (c) address,
and (d) tax year(s) during which the applicant was a member that is under examination, before an Appeals office,
and/or before a Federal court.
If, for federal income tax purposes, the applicant is either an entity (including a limited liability company) treated as
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a partnership or an S corporation, is it requesting a change from a method of accounting that is an issue under
consideration in an examination, before Appeals, or before a Federal court, with respect to a Federal income tax
return of a partner, member, or shareholder of that entity? .
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If “Yes,” the applicant is not eligible to make the change.
8 a Does the applicable revenue procedure (advance consent or automatic consent) state that the applicant does not
receive audit protection for the requested change (see instructions)? .
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b If “Yes,” attach an explanation.
9a Has the applicant, its predecessor, or a related party requested or made (under either an automatic change
procedure or a procedure requiring advance consent) a change in method of accounting within the past 5 years
(including the year of the requested change)? .
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b If "Yes," for each trade or business, attach a description of each requested change in method of accounting
(including the tax year of change) and state whether the applicant received consent.
c If any application was withdrawn, not perfected, or denied, or if a Consent Agreement granting a change was not
signed and returned to the IRS, or the change was not made or not made in the requested year of change, attach
an explanation.
10 a Does the applicant, its predecessor, or a related party currently have pending any request (including any
concurrently filed request) for a private letter ruling, change in method of accounting, or technical advice? .
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b If “Yes,” for each request attach a statement providing the name(s) of the taxpayer, identification number(s), the
type of request (private letter ruling, change in method of accounting, or technical advice), and the specific issue(s)
in the request(s).
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Is the applicant requesting to change its overall method of accounting?
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If “Yes,” check the appropriate boxes below to indicate the applicant’s present and proposed methods of
accounting. Also, complete Schedule A on page 4 of this form.
Present method:
Cash
Accrual
Hybrid (attach description)
Proposed method:
Cash
Accrual
Hybrid (attach description)
3115
Form
(Rev. 12-2009)
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