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

OMB No. 1545-0134 (Rev. June 1991) Expires 8-31-93 Department of the Treasury © For Paperwork Reduction Act Notice, see page 1 of Separate Instructions. Internal Revenue Service

Each applicant must check one of the

boxes below:

Before completing Form 1128, see Sections B and C of the General

Instructions to determine if this form must be filed.

Individual

Partnership

Estate

Form 1128 consists of three parts:

Corporation

● Part I must be completed by all applicants.

S Corporation

Personal Service Corporation

● Part II must be completed only by applicants requesting approval on a

change or retention of a tax year under an expeditious approval rule. See the

“Expeditious Approval Rules” in the Specific Instructions to determine who

qualifies. Cooperative (Sec. 1381(a))

Tax-Exempt Organization

Controlled Foreign Corporation (Sec. 957)

● Part III, Section A must be completed by all applicants requesting a ruling

from the IRS National Office on a change, adoption, or retention of their tax

year. For this type of application, a user fee must be attached. In addition to

completing Section A, corporations, S corporations, partnerships, controlled

foreign corporations, tax-exempt organizations, estates, and passive foreign

investment companies must also complete the specific section in Part III that

applies to the particular entity.

Passive Foreign Investment Company

(Sec. 1296)

Foreign Personal Holding Company

(Sec. 552)

Other Foreign Corporation

Other

(Specify entity and applicable Code section)

Name of applicant (if joint return is filed, also show your spouse’s name) Identifying number (See Specific Instructions.)

Number, street, and room or suite no. (If a P.O. box, see specific Instructions.) Service Center where tax return will be filed

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

( )

Please Type or Print

Name of person to contact (See Specific Instructions.) Telephone number of contact person

( )

All Applicants (See page 4 for required signature(s)).

1a Approval is requested to (check one):

Adopt a tax year ending ©

(If filing to adopt a tax year, go to Part III after completing Part I.)

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 ©

c If adopting or changing a tax year, indicate the short period return that will be required to be filed for the tax year

beginning © , 19 , and ending © , 19 .

2 Nature of business or principal source of income:

3 Indicate the applicant’s overall method of accounting:

Cash receipts and disbursements

Accrual

Other (explain) ©

Form 1128 (Rev. 6-91)

Part I
Form 1128 (Rev. 6-91) Page 2

Expeditious Approval Rules

(If Part II applies, file Form 1128 with the IRS Service Center where the applicant’s tax return is filed.)

Yes No

Is this a corporation described in section 3 of Rev. Proc. 84-34, 1984-1 C.B. 508 that is requesting a change in

a tax year under Rev. Proc. 84-34? ©

1

2a Is this a partnership, an S corporation, or a personal service corporation that is requesting a tax year under the

expeditious approval rules in section 4 of Rev. Proc. 87-32, 1987-2 C.B. 396, and that is not precluded from

using the expeditious approval rules under section 3 of that revenue procedure? ©

Is this a partnership, an 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 such

tax year results in no greater deferral of income to the partners or shareholders than the present tax year? ©

b

c Is this 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 the same tax year that the corporation is

retaining or changing to? ©

Is this 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 requested approval to concurrently change

to the tax year that the corporation is retaining or changing to? ©

d

Are you an individual requesting a change from a fiscal year to a calendar year under Rev. Proc. 66-50, 1966-2

C.B. 1260? ©

3

Is this a tax-exempt organization requesting a change under Rev. Proc. 85-58, 1985-2 C.B. 740, or Rev. Proc.

76-10, 1976-1 C.B. 548? ©

4

If the answer to any of the above questions is “Yes,” see the Instructions for the “Expeditious Approval Rules” and file this form

with the Internal Revenue Service Center where the income tax return of the applicant is filed. Do not file Form 1128 with the

National Office and do not include a user fee. See the Instructions for “Where To File” under Part II.

Part II
Form 1128 (Rev. 6-91) Page 3

Ruling Provisions (If Part III applies, file Form 1128 with the National Office and attach a user fee. See

Specific Instructions.)

SECTION A.—General Information

Yes No

In the last 6 years have you changed or requested approval to change your tax year? (See Part III in the Specific

Instructions.) ©

1

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

the ruling letter is not available, explain and give the date approval was granted. If a ruling letter was not issued,

explain the facts and give the date the change was implemented.

a

b If a change in tax year was granted within the last 6 years, explain in detail why another change in tax year is

necessary.

2 Do you have pending any accounting method, tax year, ruling, or technical advice request in the National Office? ©

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

in each request.

3 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.

First preceding year $ $ Second preceding year

Third 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. Corporations enter taxable income before net operating

loss deduction and special deductions. Estates enter adjusted total income.

4 Are you a 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 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.

5a Are you a U.S. shareholder in a passive foreign investment company as defined in section 1296 of the Code? ©

If “Yes,” attach a statement showing the name, address, identifying number and tax year of the passive foreign

investment company, your percentage of interest owned, and the amount of ordinary earnings and net capital

gain from the passive foreign investment company included in your income.

b Did you elect under section 1295 to treat the passive foreign investment company as a qualified electing fund? ©

Are you a member of a partnership, a beneficiary of a trust or estate, a shareholder of an S corporation, a

shareholder of an Interest Charge Domestic International Sales Corporation (IC-DISC) or a shareholder in a

Foreign Sales Corporation (FSC)? ©

6

If “Yes,” attach a statement showing the name, address, identifying number, tax year, percentage of interest 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 for the short period.

Also indicate the percentage of your gross income represented by each amount.

State the reasons for requesting the change. (Attach a separate sheet if you need more space.) This is required

by Regulations section 1.442-1(b)(1). If this information is not provided, the application will be denied.

7

SECTION B.—Corporations (other than S corporations and controlled foreign corporations)

1 Date of incorporation © Yes No

2 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 year, and the Internal Revenue Service Center where the taxpayer 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.

3 Did the corporation make any distributions to its shareholders during the short period? ©

If “Yes,” furnish the following information:

a Taxable dividends $

b Nondividend distributions (explain how determined) $

If this is a personal service corporation, attach a statement showing each shareholder’s name, type of entity

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

ownership.

4

Part III
Form 1128 (Rev. 6-91) Page 4

SECTION C.—S Corporations

1 Date of election ©

Yes No

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

Attach a statement showing each shareholder’s name, type of entity (e.g., individual, estate, trust, or qualified

Subchapter S Trust as defined in section 1361(d)(3)), address, identifying number, tax year, and percentage of

ownership.

3

SECTION D.—Partnerships

1 Date business began (See Specific Instructions.) ©

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

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, and the percentage of interest

in capital and profits.

3

Is any partner of this partnership a shareholder of a personal service corporation as defined in Temporary

Regulations section 1.441-4T(d)(1)? ©

4

If “Yes,” attach a separate sheet providing the name, address, identifying number, tax year, percentage of interest

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 E.—Controlled Foreign Corporations

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 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

Yes No

1 Form of organization: Corporation Trust Other (specify) ©

2 Date of organization ©

3 Code section under which the organization is exempt ©

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

1120-POL? ©

4

5 Date exemption was granted © . Attach a copy of the ruling letter granting exemption.

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

6 If a private foundation, is the foundation terminating its status under section 507? ©

SECTION G.—Estates

1 Date estate established ©

2 Attach a statement showing:

Name, identifying number, address, and tax year of each beneficiary and each person who is an owner or treated as an owner

of any portion of the estate.

a

Based on the taxable income of the estate entered in Part III, Section A, line 3, show 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.—Passive Foreign Investment Company

Attach a statement showing each U.S. shareholder’s name, address, identifying number, and the percentage of interest owned.

Signature—All Filers (See Specific 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’s name Date

Signature (officer of parent corporation, if applicable) Title

Signing official’s name (print or type) Date

Signature of individual or firm (other than applicant) preparing the application Date

Firm or preparer’s name

● Has the authorized representative attached a power of attorney? (For information on a power of attorney, see

“Preparer Other Than Applicant” in the Specific Instructions.) © Yes No

Yes No