INTERNAL REVENUE SERVICE

RETURN OF INFORMATION AND AUTHORIZATION AND CONSENT OF
SUBSIDIARY CORPORATION INCLUDED IN A CONSOLIDATED
INCOME TAX RETURN

TREASURY DEPARTMENT UNITED STATES 19 47

For Calendar Year 1947

__-5 1947, and ending
_.., 1947, and ending

If the return is for calen- PRINT PLAINLY CORPORATION'S NAME AND BUSINESS ADDRESS Serial
dar year 1947, file it on or
before March 15, 1948. Date Received

If the return is for a
fiscal year, file it on or
before the 15th day of the
third month following the
close of the fiscal year.

Or fiscal year beginning
Or for period beginning

Giatey

(1) Date incorporated eee ene Under laws of State of __-_-------------2n22neeee ee
(b) Pref., $.----

(8) Kind of business nnn Active or inactive ____-_------------------

(2) Capital stock outstanding at beginning of taxable year: (a) Com., $.

(4) Name of common parent corporation

(Give name of corporation which filed the consolidated income tax return for the entire affiliated group)
(5) Address of common parent corporation

(6) Internal revenue district in which consolidated return is filed

(Give district or city and State)

The above-named subsidiary corporation hereby authorizes the above-named common parent corporation (or in
the event of its failure, the Commissioner or the collector) to make a consolidated income tax return on its behalf for
the taxable year for which this form is filed, and for each taxable year thereafter that a consolidated return must be
made under the provisions of the consolidated income tax regulations.

The above-named subsidiary corporation, in consideration of the privilege of joining in the making of a consoli-
dated return with the above-named common parent corporation, hereby consents to and agrees to be bound by the
provisions of the above-mentioned regulations. This consent is applicable to the taxable year for which this form
is filed and to each taxable year thereafter that a consolidated return must be made under the provisions of the
consolidated income tax regulations.

AFFIDAVIT
We, the undersigned, president (or vice president or other principal officer) and treasurer (or assistant treasurer
or chief accounting officer) of the above-named subsidiary corporation, being severally duly sworn, each for himself
deposes and says that the above-named subsidiary has authorized him to execute this form on its behalf, and that
this form has been examined by him and the information contained herein is, to the best of his knowledge and belief,
a true, correct, and complete return of information, made in good faith, pursuant to the Internal Revenue Code and
the regulations issued thereunder.

Subscribed and sworn to before me this

-, 194___

NOTARIAL
‘SEAL

— CORPORATE,
‘SEAL

INSTRUCTIONS
Two duplicate originals of this form must be prepared by each subsidiary corporation. Each form must be
executed under the corporate seal, and sworn to by the persons then qualified to swear to a separate return of the
subsidiary. One of these forms shall be forwarded to the common parent corporation to be filed with the consolidated
income tax return; and the other filed, at or before the time the consolidated income tax return is filed, in the office
of the collector for the district prescribed for the filing of a separate return by the subsidiary.

~~ Citiey

(Forward this form to the common parent corporation to be filed with the consolidated réturn)
16—S2441-1 U8. GOVERNMENT PRINTING OFFICE




INTERNAL REVENUE SERVICE

RETURN OF INFORMATION AND AUTHORIZATION AND CONSENT OF
SUBSIDIARY CORPORATION INCLUDED IN A CONSOLIDATED
INCOME TAX RETURN

‘TREASURY DEPARTMENT UNITED STATES 19 47

For Calendar Year 1947
, 1947, and ending
_.._....-y 1947, and ending _..

Or fiscal year beginning _.

Or for period beginning _.

If the return is for calen-
dar year 1947, file it on or

before March 15, 1948.

If the retum is for a
fiscal year, file it on or
before the 15th day of the Wire and mabe)
third month following the
close of the fiscal year.

(Gity or town, postal zone number)

(1) Date incorporated _ Under laws of State of -_..

(2) Capital stock outstanding at beginning of taxable year: (a) Com., $-.-. (6) Pref., $_-.--.----------

(8) Kind of business -_.______.-_----------------------- 2-2 nee enn Active or inactive -

(4) Name of common parent corporation __
«

(5) Address of common parent corporation ___.

(6) Internal revenue district in which consolidated return is filed

(Give city and

The above-named subsidiary corporation hereby authorizes the above-named common parent corporation (or in
the event of its failure, the Commissioner or the collector) to make a consolidated income tax return on its behalf for
the taxable year for which this form is filed, and for each taxable year thereafter that a consolidated return must be
made under the provisions of the consolidated income tax regulations.

The above-named subsidiary corporation, in consideration of the privilege of joining in the making of a consoli-
dated return with the above-named common parent corporation, hereby consents to and agrees to be bound by the
provisions of the above-mentioned regulations. This consent is applicable to the taxable year for which this form
is filed and to each taxable year thereafter that a consolidated return must be made under the provisions of the
consolidated income tax regulations.

AFFIDAVIT
We, the undersigned, president (or vice president or other principal officer) and treasurer (or assistant treasurer
or chief accounting officer) of the above-named subsidiary corporation, being severally duly sworn, each for himself
deposes and says that the above-named subsidiary has authorized him to execute this form on its behalf, and that
this form has been examined by him and the information contained herein is, to the best of his knowledge and belief,
a true, correct, and complete return of information, made in good faith, pursuant to the Internal Revenue Code and
the regulations issued thereunder.

Subscribed and sworn to before me this

‘Kecounting Officer) (State titley~

NOTARIAL ignature of officer administering ~ CORPORATE
SEAL SEAL

INSTRUCTIONS
Two duplicate originals of this form must be prepared by each subsidiary corporation. Each form must be
executed under the corporate seal, and sworn to by the persons then qualified to swear to a separate return of the
subsidiary. One of these forms shall be forwarded to the common parent corporation to be filed with the consolidated
income tax return; and the other filed, at or before the time the consolidated income tax return is filed, in the office
of the collector for the district prescribed for the filing of a separate return by the subsidiary.

(File this form with the collector for the district in which the subsiaiary has its principal office or place of business)

1G--384I-1U. 5, GOV SHHMENT PRINTING OFFICE