rom 966

(Rev. April 1990)

Department of the Treasury
Internat Revenue Service

Corporate Dissolution or Liquidation
(Required under Section 6043(a) of the Internal Revenue Code)

OMB No. 1545-0041
Expires 4-30.93

| Name of corporation Employer identification number
a
| Number and street (or P.O. box number if mail is not delivered to street address) Check type of return
a
= 0 1120 O 11201
§ City or town, state, and ZIP code OD 11201e-pisc 0 11208
= DB other »
1 Date incorporated 2 Place incorporated 3 Type of liquidation
0 Complete O Partial
4 Internal Revenue Service Service Center Tax year ending
Center where last income
tax return was filed and Month Year
tax year covered
5 Date of adoption of resolution | 6 Tax year of final return
or plan of dissolution, or Was final return filed with a parent corporation (consolidated return)? 0 Yes 0 No

complete or partial liquidation
If “Yes,” enter:

Name of parent corporation >
Employer identification number >

IRS Center where consolidated return was filed >

x

Total number of shares outstanding at time of adoption of plan or liquidation

Common Preferred

Dates of any amendments to pian of dissolution.

9 Section of the Cade under which the corporation is to be dissolved or liquidated.

10 If this return concerns an amendment or Supplement to toa resolution or or plan | for which a return was filed, sive

the date filed.

Attach a certifled copy of the resolution or pian, together with all amendments or supplements not previously filed.

Under penalties of perjury, | declare that ! have examined this return, mcluding accompanying schedules and statements, and to the best of my knowledge and belief itis true,

correct, and complete.

) Signature of officer Title

Date

Instructions

Paperwork Reduction Act Notice.—We ask for this information
to carry out the Internal Revenue laws of the United States. We
need it to ensure that taxpayers are complying with these laws
and to allow us to figure and collect the right amount of tax. You
are required to give us this information.

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated average
time is:

Recordkeeping . . . Shrs., 1 min.
Learning about the law or the form . 6 min.
Preparing and sending the form to IRS . . li min.

If you have comments concerning the accuracy of these time
estimates or suggestions for making the form more simple, we
would be happy to hear from you. You can write to both the
Internal Revenue Service, Washington, DC 20224, Attention:
IRS Reports Clearance Officer, T:FP; and the Office of
Management and Budget, Paperwork Reduction Project (1545-
0041), Washington, DC 20503.

Who Must File.—A corporation files Form 966 if it is to be
dissolved or if any of its stock is to be liquidated. Exempt
organizations are not required to file Form 966. These
organizations should see the instructions for Form 990 or 990-PF.

When To File.—File Form 966 within 30 days after the resolution
or plan is adopted to dissolve the corporation or liquidate any of its
stock. If the resolution or plan is amended or supplemented after
Form 966 is filed, file an additional Form 966 within 30 days after
the amendment or supplement is adopted. The additional form
will be sufficient if you show the date the earlier form was filed
and attach a certified copy of the amendment or supplement and
all other information required by Form 966 and not given in the
earlier form.

Where To File.—File Form 966 with the Internal Revenue
Service Center where the corporation is required to file its income
tax return.

Distribution of Property.—A corporation must recognize gain or
loss on the distribution of its assets in the complete liquidation of
its stock. For purposes of determining gain or loss, the distributed
assets are valued at fair market value. Exceptions to this rule
apply to liquidation of a subsidiary and to a distribution that is
made pursuant to a plan of reorganization.

Signature.—The return must be signed and dated by the
president, vice president, treasurer, assistant treasurer, chief
accounting officer, or any other corporate officer (such as tax
officer) authorized to sign. A receiver, trustee, or assignee must
sign and date any return required to be filed on behalf of a
corporation.

U.S. Government Printing Office: 190-262-151/00106

Form 966 (Rev. 4-90)