Form 2553 - Election By A Small Business Corporation

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2553
Election by a Small Business Corporation
Form
(Under section 1362 of the Internal Revenue Code)
(Rev. December 2007)
OMB No. 1545-0146
See Parts II and III on page 3 and the separate instructions.
Department of the Treasury
The corporation can fax this form to the IRS (see separate instructions).
Internal Revenue Service
Note.
This election to be an S corporation can be accepted only if all the tests are met under Who May Elect on page 1 of the instructions; all
shareholders have signed the consent statement; an officer has signed below; and the exact name and address of the corporation and other
required form information are provided.
Part I
Election Information
A
Employer identification number
Name (see instructions)
Type
B
Number, street, and room or suite no. (If a P.O. box, see instructions.)
Date incorporated
or Print
C
City or town, state, and ZIP code
State of incorporation
D
Check the applicable box(es) if the corporation, after applying for the EIN shown in A above, changed its
name or
address
E Election is to be effective for tax year beginning (month, day, year) (see instructions)
/
/
Caution. A corporation (entity) making the election for its first tax year in existence will usually enter the
beginning date of a short tax year that begins on a date other than January 1.
F Selected tax year:
(1)
Calendar year
(2)
Fiscal year ending (month and day)
(3)
52-53-week year ending with reference to the month of December
(4)
52-53-week year ending with reference to the month of
If box (2) or (4) is checked, complete Part II
G If more than 100 shareholders are listed for item J (see page 2), check this box if treating members of a family as one
shareholder results in no more than 100 shareholders (see test 2 under Who May Elect in the instructions)
H
Name and title of officer or legal representative who the IRS may call for more information
I
Telephone number of officer
or legal representative
(
)
If this S corporation election is being filed with Form 1120S, I declare that I had reasonable cause for not filing Form 2553
timely, and if this election is made by an entity eligible to elect to be treated as a corporation, I declare that I also had
reasonable cause for not filing an entity classification election timely. See below for my explanation of the reasons the
election or elections were not made on time (see instructions).
Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete.
Sign
Here
Signature of officer
Title
Date
2553
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 18629R
Form
(Rev. 12-2007)

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