Application To Adopt, Change, or Retain a Tax Year Form 1128

OMB No. 1545-0134 (Rev. September 2003)

Department of the Treasury  See separate instructions. Internal Revenue Service

Check the appropriate box(es) to indicate the type of applicant (see page 3 of the instructions).

Individual

Partnership

Estate

Domestic corporation

S corporation

Personal service

corporation (PSC)

Cooperative (sec. 1381(a))

Possession corporation (secs. 936 and 30A)

Controlled foreign corporation (CFC) (sec. 957)

Specified foreign corporation (SFC) (sec. 898)

Foreign personal holding company (sec. 552)

Other foreign corporation

Other

(Specify entity and applicable Code section)

Name of applicant (if a joint return is filed, also enter spouse’s name) Applicant’s identifying no. (see page 3 of instructions)

Number, street, and room or suite no. (if a P.O. box, see page 3 of the instructions) Service Center where income tax return will be filed

City or town, state, and ZIP code Applicant’s area code and telephone number/Fax number

Type or Print

( )

Name of person to contact (if not the applicant or filer, attach a power of attorney) Contact person’s area code and telephone number/Fax number

( )

General Information

2a Approval is requested to (check one) (see page 3 of the instructions):

Adopt a tax year ending 

Change to a tax year ending  Retain a tax year ending 

b If changing a tax year, indicate the date the present tax year ends. 

If adopting or changing a tax year, the first return or short period return will be filed for the tax year 

beginning  , 20 , and ending  , 20 .

c

5 State the nature of the applicant’s business or principal source of income.

4 Indicate the applicant’s present overall method of accounting.

Cash receipts and disbursements method Accrual method

Form 1128 (Rev. 9-2003)

Part I

( )

)

Cat. No. 21115C

Passive foreign investment company (PFIC)

(sec. 1297)

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

3 Is the applicant’s present tax year, as stated on line 2b above, also its current financial reporting year?  Yes No

Tax-exempt organization

1

/

/ (

Foreign sales corporation (FSC) or Interest-charge

domestic international sales corporation (IC-DISC)

If “No,” attach an explanation.

Homeowners Association (sec. 528)

Important: All applicants must complete Part I and sign below. See page 2 of the instructions.

(Partnerships and PSCs: Go to Part III after completing Part I.)

Signature—All Applicants (See Who Must Sign on page 2 of the instructions.)

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. Declaration of preparer (other than applicant) is based on all information of which preparer has any knowledge.

Applicant or officer’s signature and date Signature of individual preparing the application and date

Name and title (print or type) Name of individual preparing the application

*If the application is filed by one or more U.S. shareholders of a controlled

foreign corporation or foreign personal holding company, the U.S.

shareholders must sign (see instructions).

Applicant*

Other method (specify) 

Name of firm preparing the application

Name of filer, if different than the applicant (see instructions) Filer’s identifying number

Preparer (other than applicant)
Form 1128 (Rev. 9-2003) Page 2

Automatic Approval Request (If the answer to any of the questions below is “Yes,” sign Form 1128 and

see the instructions for Where To File. Do not file with the National Office. Do not include a user fee. Do

not complete Part III. See page 3 of the instructions.)

Yes No

Is the applicant a corporation (including a homeowners association (section 528)) that is requesting a change in

tax year and is not precluded from using the automatic approval rules under section 4 of Rev. Proc. 2002-37?

1

5 Is the applicant a partnership, S corporation, or PSC that is requesting a tax year and is not precluded from

using the automatic approval rules under section 4 of Rev. Proc. 2002-38? (see page 4 of the instructions) 

Is the partnership, S corporation, or PSC requesting to change to its required tax year or a 52-53 week tax year

ending with reference to such tax year? 

6

7 Is the partnership, S corporation, or PSC (other than a member of a tiered structure) requesting a tax year that

coincides with its natural business year described in section 4.01(2) of Rev. Proc. 2002-38? (see page 4 of the

instructions for information required to be submitted) 

8 Is the S corporation requesting an ownership tax year? (see page 4 of the instructions) 

10 Is the applicant an individual requesting a change from a fiscal year to a calendar year? 

11 Is the applicant a tax-exempt organization requesting a change? 

Part II

Ruling Request (All applicants requesting a ruling must complete Section A and any other section that

applies to the entity. See page 5 of the instructions.)

Section A—General Information Yes No

Has the applicant changed its annual accounting period at any time within the most recent 48-month period

ending with the last month of the requested tax year? 

2

If “Yes” and a letter ruling was issued granting approval to make the change, attach a copy of the letter ruling,

or if not available, an explanation including the date approval was granted. If a letter ruling was not issued,

indicate when and explain how the change was implemented.

Enter the taxable income or (loss) for the 3 tax years immediately preceding the year of change and for the short

period. If necessary, estimate the amount for the short period.

Short period $ First preceding year $

Second preceding year $ Third preceding year $

Note: Individuals, enter adjusted gross income. Partnerships and S corporations, enter ordinary income. Section

501(c) organizations, enter unrelated business taxable income. Estates, enter adjusted total income. All other

applicants, enter taxable income before net operating loss deduction and special deductions.

Part III

Form 1128 (Rev. 9-2003)

Is the applicant a partnership requesting a concurrent change pursuant to section 6.10 of Rev. Proc. 2002-37

or section 5.04(8) of Rev. Proc. 2002-39? (see page 4 of the instructions) 

9

Section B—Partnerships, S Corporations, and Personal Service Corporations (PCSs) (Rev. Proc. 2002-38)

Section D—Tax-Exempt Organizations (Rev. Proc. 76-10 or 85-58) (see page 5 of the instructions)

Section C—Individuals (Rev. Proc. 2003-62) (see page 5 of the instructions)

1 Is the applicant under examination by the IRS, before an appeals office, or a Federal court? 

If “Yes,” see the instructions on page 5 for information that must be included on an attached explanation.

3 Within the most recent 48-month period, has any accounting period application been withdrawn, not perfected,

denied, or not implemented? 

4a Is the applicant requesting to establish a business purpose under section 5.02(1) of Rev. Proc. 2002-39? 

If “Yes,” attach an explanation of the legal basis supporting the requested tax year (see page 5 of the instructions).

If your business purpose is based on one of the natural business year tests under section 5.03, check the

applicable box.

b

Attach a statement showing gross receipts from sales and services (and inventory cost if applicable) for the test

period. (See page 5 of the instructions)

5

4 Is the applicant a corporation requesting a concurrent change for a CFC, FSC or IC-DISC? (see page 4 of the

instructions) 

Section A—Corporations (Other Than S Corporations or Personal Service Corporations) (Rev. Proc. 2002-37)

Annual business cycle test Seasonal business test 25-percent gross receipts test

If “Yes,” attach an explanation.

2 Does the corporation intend to elect to be an S corporation for the tax year immediately following the short period?

If “Yes” and the corporation is electing to change to a permitted tax year, file Form 1128 as an attachment to

Form 2553.

3 Is the applicant a CFC requesting a revocation of its 1-month deferral election that was made under section

898(c)(1)(B) and to change its tax year to the majority U.S. shareholder year (as defined in section 898(c)(1)(C))?
Form 1128 (Rev. 9-2003) Page 3

Section B—Corporations (other than S corporations and controlled foreign corporations) (see page 6 of instructions)

15 Enter the date of incorporation. 

Yes No

17 Is the corporation a member of an affiliated group filing a consolidated return? 

If “Yes,” attach a statement providing (a) the name, address, identifiying number used on the consolidated return,

tax year, and Service Center where the applicant files the return; (b) the name, address, and identifying number

of each member of the affiliated group; (c) the taxable income (loss) of each member for the 3 years immediately

before the short period and for the short period; and (d) the name of the parent corporation.

18a Personal service corporations (PSCs): Attach a statement providing each shareholder’s name, type of entity

(individual, partnership, corporation, etc.), address, identifying number, tax year, percentage of ownership, and

amount of income received from the PSC for the first preceding year and the short period.

16a Does the corporation intend to elect to be an S corporation for the tax year immediately following the short

period? 

b If the PSC is using a tax year other than the required tax year, indicate how it obtained its tax year.

If “No” to line 16b, attach an explanation.

b If “Yes,” will the corporation be going to a permitted S corporation tax year? 

Form 1128 (Rev. 9-2003)

8a Is the applicant a U.S. shareholder in a CFC? 

Yes No

If “Yes,” attach a statement for each CFC providing the name, address, identifying number, tax year, the

percentage of total combined voting power of the applicant, and the amount of income included in the gross

income of the applicant under section 951 for the 3 tax years immediately before the short period and for the

short period.

b Will each CFC concurrently change its tax year? 

If “Yes” to line 8b, go to Part II, line 3. 

If “No,” attach a statement explaining why the CFC will not be conforming to the tax year requested by the U.S.

shareholder.

9a Is the applicant a U.S. shareholder in a PFIC as defined in section 1297? 

If “Yes,” attach a statement providing the name, address, identifying number, and tax year of the PFIC, the

percentage of interest owned by the applicant, and the amount of distributions or ordinary earnings and net

capital gain from the PFIC included in the income of the applicant.

b Did the applicant elect under section 1295 to treat the PFIC as a qualified electing fund? 

10a Is the applicant a member of a partnership, a beneficiary of a trust or estate, a shareholder of an S corporation,

a shareholder of an IC-DISC, or a shareholder of an FSC? 

If “Yes,” attach a statement providing the name, address, identifying number, type of entity (partnership, trust,

estate, S corporation, IC-DISC, or FSC), tax year, percentage of interest in capital and profits, or percentage of

interest of each IC-DISC or FSC and the amount of income received from each entity for the first preceding year

and for the short period. Indicate the percentage of gross income of the applicant represented by each amount.

b Will any partnership concurrently change its tax year to conform with the tax year requested? 

c If “Yes” to line 10b, has any Form 1128 been filed for such partnership? 

Grandfathered (attach copy of letter ruling) Section 444 election (date of election )

Letter ruling (date of letter ruling (attach copy))

6 Corporations only, enter the losses or credits, if any, that were generated or that expired in the short period:

Generated Expiring

Net operating loss

Capital loss

Unused credits

Does the applicant or any related entity currently have any accounting method, tax year, ruling, or technical

advice request pending with the IRS National Office? 

11

If “Yes,” attach a statement explaining the type of request (method, tax year, etc.) and the specific issues involved

in each request.

12 Is Form 2848, Power of Attorney and Declaration of Representative, attached to this application? 

Does the applicant request a conference of right (in person or by telephone) with the IRS National Office, if the

IRS proposes to disapprove the application? 

13

14 Enter amount of user fee attached to this application (see page 6 of the instructions)  $

$

$

$

$

$ $

7 Enter the amount of deferral, if any, resulting from the change (see section 5.05(1), (2), (3) and 6.01(7) of

Rev. Proc. 2002-39)  $
Form 1128 (Rev. 9-2003) Page 4

Yes No

Section D—Partnerships (see page 6 of instructions)

Enter the date the partnership’s business began. 

24 Is any partner applying for a corresponding change in tax year? 

Attach a statement providing each partner’s name, type of partner (individual, partnership, estate, trust,

corporation, S corporation, IC-DISC, etc.), address, identifying number, tax year, and the percentage of interest

in capital and profits.

25

26 Is any partner a shareholder of a PSC as defined in Regulations section 1.441-3(c)? 

If “Yes,” attach a statement providing the name, address, identifiying number, tax year, percentage of interest

in capital and profits, and the amount of income received from each PSC for the first preceding year and for the

short period.

Section E—Controlled Foreign Corporations (CFC)

Attach a statement for each U.S. shareholder (as defined in section 951(b)) providing the name, address,

identifying number, tax year, percentage of total value and percentage of total voting power, and the amount of

income included in gross income under section 951 for the 3 tax years immediately before the short period and

for the short period.

Section F—Tax-Exempt Organizations

29 Type of organization: Yes No

30 Date of organization. 

31 Code section under which the organization is exempt. 

32 Is the organization required to file an annual return on Form 990, 990-C, 990-PF, 990-T, 1120-H, or 1120-POL? 

Enter the date the tax exemption was granted.  . Attach a copy of the letter ruling granting

exemption. If a copy of the letter ruling is not available, attach an explanation.

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34 If the organization is a private foundation, is the foundation terminating its status under section 507? 

Section G—Estates

35 Enter the date the estate was created. 

Attach a statement providing the name, identifying number, address, and tax year of each beneficiary and each person who

is an interested party of any portion of the estate.

36a

Based on the adjusted total income of the estate entered in Part III, Section A, line 5, attach a statement showing the

distribution deduction and the taxable amounts distributed to each beneficiary for the 2 tax years immediately before the

short period and for the short period.

b

Section H—Certain Foreign Corporations

If the applicant is a passive foreign investment company or foreign personal holding company, attach a statement providing

each U.S. shareholder’s name, address, identifying number, and percentage of interest owned.

Corporation Trust Other (specify) 

27 If the partnership is using a tax year other than the required tax year, indicate how it obtained its tax year.

23

28

Form 1128 (Rev. 9-2003)

Grandfathered (attach copy of letter ruling) Section 444 election (date of election )

Letter ruling (date of letter ruling (attach copy))

Section C—S Corporations (See page 6 of the instructions)

19 Enter the date of the S corporation election. 

20 Is any shareholder applying for a corresponding change in tax year? 

Attach a statement providing each shareholder’s name, type of shareholder (individual, estate, qualified

subchapter S Trust, electing small business trust, other trust, or exempt organization), address, identifying number,

tax year, percentage of ownership, and the amount of income each shareholder received from the S corporation

for the first preceding year and for the short period.

22

Yes No

21 If the corporation is using a tax year other than the required tax year, indicate how it obtained its tax year.

If “Yes,” each shareholder requesting a corresponding change in tax year must file a separate Form 1128 to get

advance approval to change its tax year.

Grandfathered (attach copy of letter ruling) Section 444 election (date of election )

Letter ruling (date of letter ruling (attach copy))

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