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

OMB No. 1545-0134 (Rev. August 1998)

Department of the Treasury © Instructions are separate. Internal Revenue Service

Check the appropriate box(es) to indicate the type of applicant that is filing this form (see page 2 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 (SPC) (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 give spouse’s name.) Identification number (See page 2 of the instructions.)

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

( )

Please Type or Print

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

( )

General Information (All applicants complete this part. See page 4 for required signature(s). Also see page

2 of the instructions.)

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

Adopt a tax year ending ©

(Partnerships and PSCs: 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. ©

If adopting or changing a tax year, indicate the dates of the first return or short period return that will be required to be

filed for the tax year beginning © , , and ending © ,

.

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

Other method (specify) ©

Form 1128 (Rev. 8-98)

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 included with this application. (See page 2 of the instructions.) ©

6

8 $

Passive foreign investment company (PFIC)

(sec. 1297)

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

Does the applicant request a conference of right at the IRS National Office if the IRS proposes to

disapprove the application? © Yes No

7

Is the applicant currently using the same tax year for both Federal income tax and financial reporting

purposes? © Yes No

3a

Tax-exempt organization

1

/

/ (

Foreign sales corporation (FSC) or Interest-charge

domestic international sales corporation (IC-DISC)

b If “No,” attach an explanation.
Form 1128 (Rev. 8-98) Page 2

Expeditious Approval Request (If the answer to any of the questions below is “Yes,” file Form 1128 with

the IRS Service Center where the applicant’s income tax return is filed. Do not include a user fee. See

page 3 of the instructions.)

Yes No

Rev. Proc. 92-13. 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, and as modified by Rev. Proc. 94-12, 1994-1

C.B. 565), that is requesting a change in a tax year under Rev. Proc. 92-13? ©

1

2a Rev. Proc. 87-32. Is the applicant a partnership, S corporation, or PSC 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 is not precluded from using

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

Is the applicant a partnership, S corporation, or PSC that is requesting a tax year that coincides with its natural

business year as defined in section 4.01(1) of Rev. Proc. 87-32, and the 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 the corporation’s

stock (as of the first day of the tax year to which the request relates) and the shareholders have the same tax

year the corporation is requesting? ©

Is the applicant an S corporation whose shareholders own more than 50% of the shares of the corporation’s

stock (as of the first day of the tax year to which the request relates) and the shareholders have requested

approval to concurrently change to the tax year that the corporation is requesting? ©

d

Rev. Proc. 66-50. 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

Rev. Proc. 85-58 or 76-10. 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

Part II

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

applies to the entity. See page 4 of the instructions.)

SECTION A—General Information

Yes No

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

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

copy 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.

b If a change in tax year was granted within the last 6 years, attach a statement explaining why another change

in tax year is necessary fully describing any unusual circumstances. (Subsidiaries, see page 4 of the instructions.)

Does the applicant or any related entities 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.

Short period $ First preceding year $

Second preceding year $ Third preceding year $

*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.

4 Is the applicant a U.S. shareholder in a CFC? ©

If “Yes,” attach a statement for each CFC providing the name, address, identification 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. Also indicate if the CFC will concurrently change its tax year to comply with section 898 if the

applicant’s ruling request is granted.

Part III

If the requested change was denied or not implemented, attach an explanation.
Form 1128 (Rev. 8-98) Page 3

SECTION A—General Information ( Continued from page 2. )

Yes No

5a Is the applicant a U.S. shareholder in a PFIC as defined in section 1297? ©

If “Yes,” attach a statement providing the name, address, identification 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? ©

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 in a FSC? ©

6a

If “Yes,” attach a statement providing the name, address, identification 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 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.

Attach an explanation providing the reasons for requesting the change in tax year, as required by Regulations

section 1.442-1(b)(1). If the reasons are not provided, the application will be denied. If requesting a ruling

based on a natural business year, provide the information required by Rev. Proc. 87-32 and/or Rev. Proc. 74-33,

1974-2 C.B. 489. (See page 4 of the instructions.)

7

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

1 Enter the date of incorporation. © Yes No

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

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

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

identification 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 Personal service corporations (PSCs):

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

period? ©

If “Yes,” see the instructions on page 4 for restrictions on this election.

b If the PSC is using a tax year other than the required tax year, indicate how it obtained its tax year (“grandfathered”

tax year, section 444 election, or ruling letter from the IRS National Office). ©

c If the PSC received a ruling, indicate the date of the ruling and attach a copy of the ruling

letter. ©

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

SECTION C—S Corporations

1 Enter the date of the S corporation election. ©

2 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, identification

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.

4

Yes No

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

(“grandfathered” tax year, section 444 election, or ruling from the IRS National Office). ©

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

If the corporation received a ruling, indicate the date of the ruling and attach a copy of the ruling

letter. ©

b

c

Note: Corporations wanting to elect S corporation status should see line 2 in Section B below and the instructions.

a Attach a statement providing each shareholder’s name, type of entity (individual, partnership, corporation, etc.),

address, identification number, tax year, percentage of ownership, and the amount of income such shareholder

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

Also, if “Yes,” (a) attach a copy of the Form 2553 that the taxpayer will file at the IRS Service Center, and (b)

attach a statement as to why the taxpayer is requesting to be an S corporation after the short period.

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.

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

c If “Yes” to line 6b, has any Form 1128 been filed for such partnership? ©
Form 1128 (Rev. 8-98) Page 4

Yes No

SECTION D—Partnerships (See page 4 of the instructions.)

Enter the date the partnership’s business began. ©

2 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, identification number, tax year, and the percentage of interest

in capital and profits.

3

4 Is any partner a shareholder of a PSC as defined in Temporary Regulations section 1.441-4T(d)(1)? ©

If “Yes,” attach a statement providing the name, address, identification 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 (See page 4 of the instructions.)

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

identification 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

1 Enter the type of organization: Yes No

2 Enter the date of organization. ©

3 Enter the 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

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

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

5

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

SECTION G—Estates

1 Enter the date the estate was created. ©

2 Attach a statement providing:

Name, identification number, address, and tax year of each beneficiary and each person who is an interested party of any

portion of the estate.

a

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

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

Signature—All Applicants (See page 4 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.

Signing official’s name (print or type) Title

Applicant or signing official’s signature (officer of parent corporation, if applicable) Date

Firm or preparer (print or type) preparing the application

Signature of individual (other than signing official) preparing the application Date

Corporation Trust Other (specify) ©

5a If the partnership is using a tax year other than the required tax year, indicate how it obtained its tax year

(“grandfathered” tax year, section 444 election, or ruling letter from the IRS National Office). ©

If the partnership made a section 444 election, indicate the date of the election. ©

If the partnership received a ruling letter, indicate the date of the ruling and attach a copy of the ruling

letter. ©

b

c

1

1

2 Is the applicant a SPC requesting a revocation of its election that was made under section 898(c)(1)(B)? ©

Yes No

Applicant’s name (print or type)