Form Ft 1120s - Notice Of S Corporation Status - 2008 Page 2
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4FT 1120S
Rev. 9/07
2008
Notice of
07150203
S Corporation Status
S corporation name
Federal employer I.D. number
Distributive Share
Shareholder Information
If the reporting entity is an S corporation, provide the information
The amount in this box should reflect the net amount (income
below for each resident shareholder and each nonresident
and expenses) that “flows” from the S corporation into the
shareholder’s federal adjusted gross income. The following are
shareholder (including estates and trusts) who held stock in the
S corporation any time during the S corporation’s accounting
examples (but not all-inclusive) of what should not be included
in computing the net amount: charitable contributions, health
period ending in 2007. If the reporting entity is a qualified Sub-
chapter S subsidiary, list the name and federal employer identi-
insurance premiums paid on behalf of more than 2% share-
fication number of the parent S corporation. If any shareholder is
holders, and investment interest expenses that are allowable to
an individual only as an itemized deduction on Schedule A of IRS
an estate or trust other than an employee stock option plan, also
list the name, Social Security number, and address of each ben-
form 1040.
eficiary of the estate or trust.
Please check the box if this year’s shareholder information either (i) includes names that were not listed on last year’s
notice or (ii) excludes names that were listed on last year’s notice.
Use UPPERCASE letters.
Shareholder Social Security #/FEIN #
% of ownership
Distributive $ share
1.
0 0
,
.
,
,
.
Shareholder first name
M.I. Last name
Home address (number and street)
City
State
ZIP code
2.
Shareholder Social Security #/FEIN #
% of ownership
Distributive $ share
0 0
,
,
,
.
.
Shareholder first name
M.I. Last name
Home address (number and street)
City
State
ZIP code
Distributive $ share
Shareholder Social Security #/FEIN #
% of ownership
3.
0 0
,
,
,
.
.
Shareholder first name
M.I. Last name
Home address (number and street)
City
State
ZIP code
For additional shareholders, please use a copy of this form.
Attach additional copies as necessary.
2008
FT 1120S
pg. 2 of 4
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