Mail to:
CBT-2553-R
State of New Jersey
NJ Division of Revenue
(2-08)
Division of Taxation
PO Box 252
RETROACTIVE S ELECTION APPLICATION
Trenton, NJ 08646-0252
(609) 292-1730
Complete and attach to form CBT-2553
This application is for authorized corporations that desire retroactive New Jersey S Corporation status. If New Jersey S corporation status has not
been previously approved, attach this form to the New Jersey S Corporation Election form, CBT-2553. If New Jersey S Corporation status has been
previously approved, submit this form with a copy of the original CBT-2553 filed with the Division of Revenue.
Part I
Corporate Information
(Type or Print)
Name of Corporation
Federal Employer Identification Number
NJ Corporation Serial Number
Part II
Required Payment (Must be submitted with this application)
Date requested to begin this election ________/________/________
Number of calendar or fiscal period’s included: ___________________________
Number of periods x $100.00 = $ ______________.00
Part III
Corporate Consent Statement
By signing this statement, the corporate officer affirms that this corporation is a New Jersey authorized corporation which meets the requirements for
a New Jersey S corporation as set forth by law and on the form CBT-2553 and meets the standards as set forth in N.J.A.C. 18:7-20.3.
Under penalties of perjury, I declare that I have examined this application, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete
________________________________________________________________ _____________________________________________________
Name of authorized officer
Title
________________________________________________________________ _____________________________________________________
Signature of authorized officer
Date
Part IV
Shareholder’s Consent Statement
- By signing this election, we the undersigned shareholders, consent (1) to the corporation’s retroactive
election to be treated as a New Jersey S corporation under N.J.S.A. 54:10A-1, et seq., (2) that New Jersey shall have the retroactive right and
jurisdiction to tax and collect the tax on each shareholder’s S corporation income, as defined in N.J.S.A. 54A:5-10 and (3) that such right and jurisdiction
shall not be affected by a change of a shareholder’s residency except as provided in N.J.S.A. 54A:1-1, et seq. Shareholders must sign, date and
provide the requested information below. For this election to be valid, the signed consent of every past and present shareholder during the consent
period, every past and present person having a community property interest in the corporation’s stock, and each past and present tenant in common,
joint tenant, and tenant by the entirety must appear below or be attached to this form. If more space is needed, a continuation sheet reporting the exact
information for additional shareholders or a second consent statement must be attached to this form.
Name of each past and present shareholder,
* Share-
Stock Owned
each person having a community property
holder’s
Social Security Number
Signatures must be provided
interest in the corporation’s stock, and each
state of
or
tenant in common, joint tenant, and tenant by
residency
Employer Identification Number
Number
Dates
the entirety, past and present. (A husband
for an estate or qualified trust
of
acquired
and wife (and their estates) are counted as one
Signature
Date
shares
shareholder).
* You must provide the address of any shareholder who is not a resident of New Jersey on a rider and attach it to this form.