Form 851 - Affiliations Schedule

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851
Affiliations Schedule
Form
OMB No. 1545-0025
(Rev. December 2010)
File with each consolidated income tax return.
▶
Department of the Treasury
For tax year ending
,
Internal Revenue Service
Name of common parent corporation
Employer identification number
Number, street, and room or suite no. If a P.O. box, see instructions.
City or town, state, and ZIP code
Part I
Overpayment Credits, Estimated Tax Payments, and Tax Deposits (see instructions)
Portion of
Employer
Portion of tax
Corp.
overpayment credits
Name and address of corporation
identification
deposited with
No.
and estimated
number
Form 7004
tax payments
1
Common parent corporation
Subsidiary corporations:
2
3
4
5
6
7
8
9
10
Totals (Must equal amounts shown on the consolidated tax return.)
.
▶
Part II
Principal Business Activity, Voting Stock Information, Etc. (see instructions)
Stock holdings at beginning of year
Did the subsidiary
PBA
make any nondividend
Corp.
Number
Owned by
Principal business activity (PBA)
Code
Percent of
Percent of
distributions?
No.
of
corporation
No.
voting power
value
shares
no.
Yes
No
Common parent corporation
1
Subsidiary corporations:
2
%
%
3
%
%
4
%
%
5
%
%
6
%
%
7
%
%
8
%
%
9
%
%
10
%
%
851
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 12-2010)
Cat. No. 16880G

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