Form Rv-F1308301 - Consolidated Net Worth Election Registration Application
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TENNESSEE DEPARTMENT OF REVENUE
CONSOLIDATED NET WORTH
ELECTION REGISTRATION APPLICATION
This application must be completed by affiliated groups and financial institution affiliated groups electing to compute the net
worth base for franchise tax purposes on a consolidated basis.
CHECK BOX:
NEW ELECTION
AMEND ELECTION TO ADD OR REMOVE GROUP MEMBERS
REVOKE ELECTION
CHECK IF APPLICATION IS FOR A FINANCIAL INSTITUTION AFFILIATED GROUP
1. Effective Date of Election/Revocation
FISCAL YEAR BEGINNING:
MO:
DAY:
YR:
FISCAL YEAR ENDING:
MO:
DAY:
YR:
F&E Account Number:
FEIN:
Secretary of State Number:
2. Legal Name of Affiliated Group
Mailing Address - Street/Highway
3. Location Address - Street/Highway - No PO Box or RR#
City, State, Zip
City, State, Zip:
Business Fax:
4. Business Phone:
Business E-mail:
5. DESCRIBE THE GROUP’S PREDOMINANT BUSINESS ACTIVITY, STATING THE MAJOR PRODUCTS AND/OR SERVICES SOLD. (AFFILIATED GROUP)
LIST ALL AFFILIATED GROUP MEMBERS OR FINANCIAL INSTITUTION AFFILIATED GROUP MEMBERS SUBJECT
TO TENNESSEE F&E TAX.
CHECK IF ENTITY IS A SINGLE
6. CHECK IF AMENDED:
NEW MEMBER
REVOKE MEMBER
EFFECTIVE DATE:
MEMBER LLC FILING AS A DIVISION
OF THE PARENT
Affiliated Group Member Name, Mailing Address, and Location Address
Legal Name
Mailing Address - Street/Highway
Location Address - Street/Highway - No PO Box or RR#
City, State, Zip
City, State, Zip:
Business Phone:
Business E-mail:
Business Fax:
Secretary of State Number:
FEIN:
F&E Account Number:
DESCRIBE THE INDIVIDUAL BUSINESS ENTITY’S PREDOMINANT BUSINESS ACTIVITY, STATING THE MAJOR PRODUCTS AND/OR SERVICES SOLD.
8. The statements made on this application are true to the best of my knowledge and belief.
DEPARTMENT USE ONLY
This application must be signed by the individual owner, a partner, or an officer of the corporation.
SIGN HERE:
Owner, Partner, or Officer (Do not use stamp.)
RV-F1308301 (Rev. 11-08)
INTERNET (11-08)
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