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

OMB No. 1545-0134 (Rev. April 1996)

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

Check the appropriate box to indicate who is filing this form.

Individual

Partnership

Estate

Corporation

S Corporation

Personal Service Corporation

Cooperative (Sec. 1381(a))

Possession Corporation (Sec. 936)

Controlled Foreign Corporation (Sec. 957)

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 a joint return is filed, also give spouse’s name.) Identifying 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 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 .

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. 4-96)

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 page 2 of the instructions.) ©

6

8 $

Passive Foreign Investment Company (Sec. 1296)

For Paperwork Reduction Act Notice, see separate instructions.

Does the applicant request a conference of right at the IRS National Office? (See page 2 of the

instructions.) © Yes No

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3 Is the applicant using the same tax year for both Federal income tax and financial reporting purposes? © Yes No

Tax-Exempt Organization

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/

/ (
Form 1128 (Rev. 4-96) Page 2

Expeditious Approval Requests (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

pages 2 and 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 by Rev. Proc. 94-12, 1994-1 C.B. 565, and 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 Rev. Proc. 87-32.—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,

but 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 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? ©

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Part II

Ruling Requests (All applicants requesting a ruling must complete Section A and any other specific section

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

SECTION A—General Information (See page 4 of the instructions.)

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 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.

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 fully describing any unusual circumstances. (Subsidiaries see page 4 of the instructions.)

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.

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 controlled foreign corporation (CFC)? ©

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

applicant’s request is granted.

Part III

If the requested change was denied or not implemented, attach an explanation.
Form 1128 (Rev. 4-96) Page 3

SECTION A—General Information (See page 4 of the instructions.) ( Continued from page 2. )

Yes No

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

If “Yes,” attach a statement providing 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)? ©

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If “Yes,” attach a statement providing the name, address, identifying 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 partnership, trust, estate, S corporation,

IC-DISC, or FSC for the first preceding year and for the short period. Indicate the percentage of gross income

of the applicant represented by each amount. Also indicate any partnership that will concurrently change its tax

year to comply with section 706 if the applicant’s request is granted.

Attach an explanation providing the reasons for requesting the change in tax year. This explanation is 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, see page 4 of the instructions.)

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SECTION B—Corporations (other than S corporations and controlled foreign corporations) (See page 4 of the instructions.)

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, 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 Personal service corporations: 

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 corporation is using a tax year other than the required tax year, indicate how it obtained its tax year (i.e.,

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

c If the corporation received a ruling, indicate the date of the ruling and provide 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 (See page 4 of the instructions.)

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 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.

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Yes No

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

“grandfathered,” 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 provide a copy of the ruling

letter. ©

b

c

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

instructions.

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

etc.), address, identifying number, tax year, and percentage of ownership.
Form 1128 (Rev. 4-96) 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 (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 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,

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 Enter the form of organization:

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 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, 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 providing each U.S. shareholder’s name, address, identifying 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.

Applicant’s name (print or type) Date

Applicant’s signature (officer of parent corporation, if applicable) Title

Signing official’s name (print or type) Date

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

Firm or preparer’s name (print or type)

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 (i.e.,

“grandfathered,” section 444 election, or ruling 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, indicate the date of the ruling and provide a copy of the ruling

letter. ©

b

c

Printed on recycled paper

1

1

Is the applicant a specified foreign corporation requesting a revocation of its election that was made under

section 898(c)(1)(B)? ©

2

Yes No