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

OMB No. 1545-0134 (Rev. June 1993) Expires 5-31-96 Department of the Treasury © Instructions are separate. Internal Revenue Service

Check one of the boxes below: Before completing Form 1128, see the 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 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.

Specified Foreign Corporation (Sec. 898)

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 give spouse’s name.) Identifying number (See instructions.)

Number, street, and room or suite no. (If a P.O. box, see page 2 of 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

( )

Please Type or Print

Name of person to contact (If not applicant, attach power of attorney.) Contact person’s area code and telephone number/Fax number

( )

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

3a Approval is requested to (check one):

Adopt a tax year ending ©

(Partnerships and personal service corporations: 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 .

4 Nature of applicant’s business or principal source of income:

5 Indicate the applicant’s overall method of accounting:

Cash receipts and disbursements method

Accrual method

Other method (explain) ©

Form 1128 (Rev. 6-93)

Part I

( )

( )

Cat. No. 21115C

Is Form 2848, Power of Attorney and Declaration of Representative, attached to this application? © Yes No

Enter amount of User Fee attached to this application. (See instructions for Part I.) ©

1

2 $

Passive Foreign Investment Company (Sec. 1296)

For Paperwork Reduction Act Notice, see separate instructions.
Form 1128 (Rev. 6-93) Page 2

Expeditious Approval Rules (See instructions.)

Yes No

Is the applicant a corporation described in section 4 of Rev. Proc. 92-13, 1992-1 C.B. 665 (as modified and

amplified by Rev. Proc. 92-13A, 1992-1 C.B. 668), that is requesting a change in a tax year under Rev. Proc.

92-13? ©

1

2a Is the applicant 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 the applicant 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 the applicant an S corporation whose shareholders own more than 50% 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 the applicant an S corporation whose shareholders own more than 50% 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

Is the applicant 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 the applicant 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,” 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 Where to file in

Part II of the instructions.

Part II
Form 1128 (Rev. 6-93) Page 3

Ruling Provisions 

SECTION A—General Information (See instructions.)

Yes No

1 In the last 6 years has the applicant changed or requested approval to change its tax year? ©

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, attach an explanation and give the date the 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, attach an explanation discussing why another change

in tax year is necessary.

Does the applicant have any accounting method, tax year, ruling, or technical advice request pending with the National

Office? ©

2

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 Is the applicant 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, 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.

5a Is the applicant a U.S. shareholder in a passive foreign investment company as defined in section 1296? ©

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

investment company, the percentage of interest owned by the applicant, and the amount of ordinary earnings

and net capital gain from the passive foreign investment company included in the income of the applicant.

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

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 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 gross income of the applicant represented by each amount.

State the reasons for requesting the change in tax year. (Attach a separate sheet if more space is needed.) This

information is required by Regulations section 1.442-1(b)(1). If the reasons are not provided, the application will

be denied.

Note: Corporations that want to elect S corporation status should see question 2 in Section B below and the

related instructions.

7

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

1 Date of incorporation © Yes No

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 year, and the Internal Revenue 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.

4 If the applicant 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.

Part III

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

2 Does the corporation intend to elect to be treated as an S corporation for the tax year immediately following the

short period? ©

If “Yes,” see the instructions for restrictions on this election.
Form 1128 (Rev. 6-93) Page 4

SECTION C—S Corporations (See instructions.)

1 Date of S corporation 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 (i.e., individual, estate, trust, or qualified

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

ownership.

4

SECTION D—Partnerships (See instructions.)

1 Date business began ©

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 a shareholder of a personal service corporation as defined in Temporary Regulations section

1.441-4T(d)(1)? ©

4

If “Yes,” attach a statement 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 (See instructions.)

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: 

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 was created ©

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 adjusted total 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 Applicants (See 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

Yes No

Corporation Trust Other (specify) ©

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

(i.e., “grandfathered,” section 444 election, or ruling from the IRS National Office).

If the corporation received a ruling, indicate the date of the ruling’s approval and provide a copy of the ruling

letter . If the corporation made a section 444 election, indicate the date of the

election ©