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

mpeasuny DevAnrMENT UNITED STATES 1 9 4 8

For Calendar Year 1948
Or fiscal year beginning _, 1948, and ending
_.......-y 1948, and ending

Or for period beginning

If the return is for calen- PRINT PLAINLY CORPORATION’S NAME AND BUSINESS ADDRESS
dar year 1948, file it on or
before March 15, 1949.

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

(1) Date incorporated Under laws of State of -__._--------------n-n--aeeee
(2) Capital stock outstanding at beginning of taxable year: (a) Com., $......--------------- (b) Pref., $__------------
(8) Kind of business nena Active or inactive

(4) Name of common parent corporation
(Give name of corporation whieh flied the consolidated income tax return fc

(5) Address of common parent corporation -........-...-----------------------------------~ -

(6) Internal revenue district in which consolidated return is filed sera: -
ive

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 an
the regulations issued thereunder.

Subscribed and sworn tobeforeme this, i

ween day of ______..---------------------- 194__. - - _ meeeppene - —
G@ireasarer, Assistant Treasurer, or Ghief Accounting Oificer) (State title)
NOTARIAL ~ 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.

(Forward this form to the common parent corporation to be filed with the consolidated return)

16—S6161-1—_v, 6, 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 1 9 4 8

For Calendar Year 1948
Or fiscal year beginning _ » 1948, and ending

Or for period beginning -..

..--....-» 1948, and ending ..._.....

If the return is for calen- PRINT PLAINLY CORPORATION’S NAME AND BUSINESS ADDRESS
dar year 1948, file it on or
before March 15, 1949. _

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

Gireet and mambe)

City or town, postal zone number) —

(1) Date incorporated Under laws of State of -__...-.---------------e-eeenneneeeee
(6) Pref., $...-----—--—--

Active or inactive ____..-----.------------

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

(4) Name of common parent corporation

filed the consolidated income tax return for the entire affiliated grouy

(Give name of corporatic
(5) Address of common parent corporation

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

(Give di 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

‘resident or other principal officer) (tate titiey

ween nnnnnnnee- May Of ____- ee eee ennen nanan , 194...

(ireasurer, Assistant ‘Freasurer, or Chief Accounting Officer) State titiey

NOTARIAL ~~ Gignature of officer administering oat CORPORATE,
‘SEAL oath) SEAL

Cities

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 subsidiary has its principal office or place of business)
16—S6161-1 U.S. GOVERNMENT PRINTING OFFICE.