ron 1128 Application for Change in Accounting Period

(Rev. January 1989)

OMB No. 1545-0134

Ex 1-30-91
Department of the Treasury > For Paperwork Reduction Act Notice, see page 1 of separate instructions. res 930-9
Internal Revenue Service
Name of applicant (if joint return is filed, also show your spouse's name) Identifying number (See Specific Instructions) Check one:
¢ 1 Individual
& Number and street (P.O. box number if mail 1s not delivered to street address) Service Center where return will be filed o Partnership
3]
2 O Estate
1) City or town, state, and ZIP code Applicant's telephone number O trust
3
3 ¢ ) CO Corporation
| Name of person to contact (see Specific Instructions) Telephone number of contact person C1 sCorporation
i ) CO Personal Service
Corporation
DO NOT FILE FORM 1128 IF YOU MEET ANY OF THE EXCEPTIONS UNDER GENERAL INSTRUCTION B. O tc-pisc
O Cooperative
DO NOT CHANGE YOUR TAX YEAR UNTIL THE COMMISSIONER HAS APPROVED YOUR REQUEST. (Gee. 1381(2))
1 Tax-Exempt
Organization
O Controlled
SECTION A.—All Filers Foreign Corp.
O  rsc
1 Foreign Corp.

la Present taxyearends |1b Permission is requested to change to a tax year ending | 1c Permission is requested to adopt a tax year ending

1d Permission is requested to retain a tax year ending (see items (e) and (f) in Exceptions under General Instruction B).

-ending.

2 The tax year change or adoption will require a return for a short period beginning .

3 Nature of business or principal source of income

4 Whatis your overall method of accounting? ([] Cash receipts and disbursements [1] Accrual
1 Other (explain) >

5 Are you an individual requesting a change from a fiscal year to a calendar year ul under Rev. Proc. 66-50, 1966-2 CE B. [Yes | No
1260? (If “Yes,” file Form 1128 with the applicable Service Center.) :
Mh

6 In the last 6 years have you changed or requested permission to > change your accounting period, your overall method of
accounting or the accounting treatment of any item? . :

If Yes’ and there was a ruling letter issued granting permission to make the change, attach a copy. If a copy of the
ruling letter is not available, explain and give the date permission was granted. If a ruling letter was not required, e.g.,
corporations using Rev. Proc. 84-34, 1984-1 C.B. 508, or Regulations section 1.442-1(c), explain the facts and give the
date the change was implemented.

If a change in accounting period was granted within the last 6 years, explain in detail the unusual circumstances
requiring this change.

7 Doyou have pending any accounting method, accounting period, ruling, or technical advice request in the National Office?

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

8 Enter the taxable income* or (loss) for the 3 tax years immediately before the short period and for the short period. If
necessary, estimate the amount for the short period.

Third preceding year Second preceding year First preceding year Short period

$ $.

$.
*Individuals enter adjusted gross income. Partnerships and S corporations enter ordinary income. Section 501(c)
organizations enter unrelated business taxable income.

9 Are youa U.S. shareholder in a controlled foreign corporation (CFC)? .

If “Yes,” attach a statement for each CFC stating the name, address, identifying number, ‘tax year, your percentage of YY

total combined voting power, and the amount of income included in your gross income under section 951 for the 3 tax
years immediately before the short period and for the short period.

10 Are you a member of a partnership, a beneficiary of a trust or estate, a shareholder of an S corporation, or a shareholder
of an Interest Charge De Domestic International Sales Corporation (Ic. DISC) or a shareholder ina Foreign Sales Corporation
(FSC)? :
If “Yes,"”’ attach a statement t showing the name, . address, identifying number, tax year, 1, percentage of interest i in capital
and profits, or percentage of interest of each IC-DISC and the amount of income received from each partnership, trust,
estate, S corporation, IC-DISC, or FSC for the first preceding year and the short period.

Form 112

B (Rev. 1-89)


Form 1128 (Rev. 1-89) Page 2

SECTION A.—All Filers (continued)

Yes No
11 Are you an unincorporated syndicate, group, pool, or joint venture that has elected, under the provisions of Regulations Mh
section 1.761-2(b), not to be treated as a partnership?. . :
If “Yes,” provide a copy of the statement described in Regulations s section 1 761: 20). it no formal election was made, lj
describe in detail why you are not considered a partnership for Federal income tax purposes. yy

12 a Are you an S corporation whose shareholders hold more than half of the shares of stock (as of the first day of the tax year
to which the request relates) of the corporation and have: (1) the same tax year, or (2) are ® concurrently changing t to the Ut
tax year that the corporation retains or changes to per Section A, item 1b or 1d? : :

b Is the corporation described in section 3.01(2) of Revenue Procedure 87-32?

13 a Are you a partnership, S corporation, or a personal service corporation that is retaining or changing to a tax year that
coincides with its natural business year as defined in section 4.01(1) of Rev. Proc. 87-32 and as verified by its
satisfaction of the requirements of section 4.02(1) of Rev. Proc. 87-32? . :

Mh

b If the partnership, S corporation, or personal service corporation is changing to a natural business year as defined in
section 4.01(1), do you represent that such tax year results in less deferral of income to the partners or shareholders
than your present tax year? . .

c Is the partnership, S corporation, or personal se service : corporation described i in n section 3. on) of Rev. Proc. 87: 327 ‘Gee
General Instruction G, “Rev. Proc. 87-32” for necessary attachments) . .

14 State the reasons for requesting the change. (Attach a separate sheet if you need more espace)

SECTION B.—Partnerships

1 Date business began. (See specific instructions for Section B.) >
2 Is any partner applying for a corresponding change in accounting period? :
3 Attach a statement showing each partner's name, type of partner (e.g., individual, partnership, estate, trust, corporation,

S corporation, IC-DISC, etc.), address, identifying number, tax year, the percentage of interest in capital and profits, and
how the interest was acquired.

4 |s any partner of this partnership a member of a personal service corporation as defined in Temporary Regulations section
1.441-4T(d)(1)? .
If Yes," attach a separate sheet ‘providing ti the name, address, identifying number, tax year, . percentage of interest i in

capital and profits, and the amount of income received from each personal service corporation for the first preceding year
and the short period.

SECTION C.—All Corporations

1 Date of incorporation >

2 Is the change being requested by a subsidiary who became a member of an affiliated eroup to fein with the ” Parent
corporation in the filing of a consolidated return for the short period? . .
If “Yes,"” DO NOT FILE THIS FORM. SEE “EXCEPTIONS” IN GENERAL INSTRUCTION B.

3 Is the corporation a member of an affiliated group filing a consolidated return? .
If “Yes,” attach a statement showing (a) the name, address, identifying number used on ‘the consolidated return, “the tax Y
year, and the Internal Revenue Service Center where the taxpayer files the return; and (b) the name, address, and

identifying number of each member of the affiliated group. Designate the parent corporation and the taxable income
(loss) of each member for the 3 years immediately before the short period and for the short period.

4 Did the corporation pay any dividends to its shareholders during the short period?
If “Yes,” furnish the following information:
(a) Taxable dividends .
(b) Nontaxable dividends (explain how determined) .

5 Are you requesting a change fora corporation under Rev. Proc. ‘ga: 342 ‘Wr "Yes," file Form 1128 with the applicable
Service Center.)

6 If you are a personal service corporation, ‘attach z a statement showing each shareholder’ 's name, "address, identifying
number, tax year, percentage of ownership, and type of entity (e.g., individual, partnership, corporation, etc.)



Form 1128 (Rev. 1-89) Page 3

SECTION D.—S Corporations

Yes No

1 Date of election >

2 Attach a statement showing each shareholder's name, address, identifying number, tax year, percentage of ownership,
and type of entity (e.g., individual, estate, trust, or qualified Subchapter S Trust as defined in section 1361(d)(3)).

3 Has the newly electing S corporation filed Form 2553, Election by a Small Business Corporation, to adopt, retain, or TG
change its accounting period? Be woe
If “Yes,"’ do not file this form.

SECTION E.—Tax-Exempt Organizations
1 Form of organization: D) Corporation _L Trust O Other (specify) > -

2 Date of organization >

3 Code section under which you are exempt >

4 Are you required to file an annual return on Form 990, 990-C, 990-PF, 990-T, 1120-H, or 1120-POL? .

5 Date exemption was granted > .--. Attach a copy of the ruling letter granting exemption. Ifa a

copy of the letter is not available, attach explanation. . Uf,
6 Ifa private foundation, is the foundation terminating its status under section 507?
7 Are you requesting a change for a tax-exempt organization under Rev. Proc. 85-58, 1985-2 C.| B. 740, or 1 Rev. Proc. 76. 10, Mh,

1976-1 C.B. 548? (If “Yes,” see instructions for Section E.)
SECTION F.—Interest Charge Domestic International Sales Corporations or Foreign Sales Corporations

1 Date of election >

2 Attach a statement stating the name, address, identifying number, tax year, and the percentage of ownership and
percentage of voting power of each shareholder.

SECTION G.—Controlled Foreign Corporation

1 Enter the tax year that was used for tax purposes >

2 Attach a statement for each U.S. shareholder (as defined in section 951(b)) stating the name, address, identifying
number, tax year, percentage of total combined voting power, and the amount of income included in the gross income
under section 951 for the 3 tax years immediately before the short period and for the short period.

SIGNATURE—All Filers (See Specific Instructions)

Under penalties of perjury, | declare that I have examined this application, including accompanying schedules and statements, and to the best of my
knowledge and belief tis true, correct, and complete. Declaration of preparer (other than applicant) is based on all information of which preparer has any
nowledge.

Applicant's name

Signature Titie

Firm or preparer’s name