Form 973 Corporation Claim for Deduction

for Consent Dividends

OMB No. 1545-0044 (Rev. December 2003)

Department of the Treasury

Internal Revenue Service

(Under Section 561 of the Internal Revenue Code)

For tax year beginning , 20 , and ending , 20 .

Name of corporation Employer identification number

Number of shares

outstanding on last

day of tax year

Number of shares

outstanding on first

day of tax year

Actual distributions per

share made in tax year * Class of stock Description of dividend rights

* If a distribution was not made on all shares of any class, describe any unequal treatment:

Describe any other changes in outstanding stock during the tax year:

(Use more sheets if necessary.)

For Paperwork Reduction Act Notice, see back of form. Cat. No. 17059P Form 973 (Rev. 12-2003)
Form 973 (Rev. 12-2003) Page 2

If any stock outstanding on the last day of the tax year is entitled to cumulative dividends, show the amount for earlier years

unpaid at the beginning of the tax year. Give the class or classes of stock involved.

(Use more sheets if necessary.)

Instructions

Section references are to the Internal Revenue Code unless

otherwise noted.

Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue

laws of the United States. You are required to give us the

information. We need it to ensure that you are complying

with these laws and to allow us to figure and collect the right

amount of tax.

Recordkeeping 3 hr., 31 min.

Learning about the law or the form 30 min.

Preparing and sending the form to the IRS 34 min.

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is:

Purpose of form. Form 973 is filed by a corporation claiming

a consent dividend deduction under section 565.

Who may file. The consent dividend provisions apply to

corporations that reasonably believe that they are subject to

the accumulated earnings tax, personal holding companies,

foreign personal holding companies, regulated investment

companies, and real estate investment trusts.

How to file. Attach Form 973 to the corporation’s income

tax return for the tax year the corporation claims the consent

dividend deduction.

Nonresident aliens and foreign shareholders. If the

corporation receives a Form 972 from a nonresident alien or

other foreign shareholder, the corporation must pay any

withholding tax it would have withheld if the dividend had

been actually paid (see Regulations section 1.565-5(a) and

sections 1441 and 1442).

See the instructions for these forms for more detailed

information on filing and transmitting the payment.

If you have comments concerning the accuracy of these

time estimates or suggestions for making this form simpler,

we would be happy to hear from you. You can write to the

Internal Revenue Service at the address listed in the

instructions of the tax return with which this form is filed.

You are not required to provide the information requested

on a form that is subject to the Paperwork Reduction Act

unless the form displays a valid OMB control number. Books

or records relating to a form or its instructions must be

retained as long as their content may become material in the

administration of any Internal Revenue law. Generally, tax

returns and return information are confidential, as required by

section 6103.

Limitations. A consent dividend deduction may only be

taken as to the amount stated on Form(s) 972 (see below),

for “consent stock” (as defined in section 565(f)(1)), which is

not a “preferential dividend” (as defined in section 562(c)),

and which would constitute a “dividend” (as defined in

section 316) if actually paid.

Use the following forms to report and send the tax

withheld.

● Form 1042, Annual Withholding Tax Return for U.S.

Source Income of Foreign Persons;

● Form 1042-S, Foreign Person’s U.S. Source Income

Subject to Withholding; and

● Form 1042-T, Annual Summary and Transmittal of Forms

1042-S.

For each shareholder who agreed to treat the consent

dividend as a taxable dividend, the corporation must also

attach to its income tax return either the signed Form 972,

Consent of Shareholder To Include Specific Amount in Gross

Income, or an unsigned Form 972 with the same information

stated on the signed Form 972. If the corporation submits an

unsigned Form 972, it must retain the original, signed Form

972 in its records.