Corporate Dissolution or Liquidation Form 966

(Rev. April 2004) O

(Required under section 6043(a) of the Internal Revenue Code) Department of the Treasury

Internal Revenue Service

Name of corporation Employer iden

Number, street, and room or suite no. (If a P.O. box number, see page 2 of instructions.) Check type of r

1120 

City or town, state, and ZIP code 1120-

Please type or print

Other 

1 Date incorporated 2 Place incorporated 3 Type of liquidation

Complete Partial

5 7b

Common 

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

9 Date(s) of any amendments to plan of dissolution

10 Section of the Code under which the corporation is to be dissolved or liquidated

11 If this return concerns an amendment or supplement to a resolution or plan, enter the date

the previous Form 966 was filed

Attach a certified copy of the resolution or plan and all amendments or supplements not previou

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of m

it is true, correct, and complete.

Signature of officer Title Date

Instructions

Who Must File

Form 



Service Center where corporation filed

its immediately preceding tax return

Last month, day, and year of

immediately preceding tax year

Last month, day, and year of

final tax year

Was corpo

filed as pa

income tax 

complete 7

Name of common parent Employer identification number

of common parent

Service Ce

consolidate

6 7a

7c 7d 7e

Yes 

Cat. No. 17053B

Date resolu

or partial liq

4

When To File

Caution: Do not file Form 966 for a deemed liquidation (such as

a section 338 election or an election to be treated as a

disregarded entity under Regulations section 301.7701-3).

A corporation (or a cooperative filing Form 990-C, Farmers’

Cooperative Association Income Tax Return) must file Form 966

if it adopts a resolution or plan to dissolve the corporation or

liquidate any of its stock. Exempt organizations and qualified

subchapter S subsidiaries are not required to file Form 966.

These organizations should see the instructions for Form 990,

Return of Organization Exempt from Income Tax or Form

990-PF, Return of Private Foundation or Section 4947(a)(1)

Nonexempt Charitable Trust Treated as a Private Foundation and

Form 8869, Qualified Subchapter S Subsidiary Election,

respectively.

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 another Form 966 within 30 days after the

amendment or supplement is adopted. The additional form will

be sufficient if the date the earlier form was filed is entered on

line 11 and a certified copy of the amendment or supplement is

attached. Include all information required by Form 966 that was

not given in the earlier form.

Where To File

File Form 966 with the Internal Revenue Servic

applicable address shown below:

For . . . The 

is . 

Corporations filing Form 1120-F, or

1120-FSC; corporations whose principal

business, office, or agency is located in a

foreign country or U.S. possession; and

corporations claiming the possessions

corporation tax credit under sections 30A

and 936

Filers of Form 990-C or 1120-PC; and

corporations (not listed above, except

Form 1120-IC-DISC) whose total assets

at the end of the tax year are $10 million

or more or whose principal business,

office, or agency is located in Alabama,

Alaska, Arizona, Arkansas, California,

Colorado, Florida, Georgia, Hawaii, Idaho,

Iowa, Kansas, Louisiana, Minnesota,

Mississippi, Missouri, Montana,

Nebraska, Nevada, New Mexico, North

Dakota, Oklahoma, Oregon, South

Dakota, Tennessee, Texas, Utah,

Washington, or Wyoming

All other corporations not listed above. 
We ask for the information on this form to car

Revenue laws of the United States. You are re

the information. We need it to ensure that you 

with these laws and to allow us to figure and c

amount of tax.

The time needed to complete and file this fo

depending on individual circumstances. The e

time is:

Recordkeeping 

Learning about the law or the form 

Preparing and sending the form to the IRS 

Distribution of Property

If you have comments concerning the accur

estimates or suggestions for making this form 

be happy to hear from you. You can write to t

Coordinating Committee, Western Area Distrib

Rancho Cordova, CA 95743-0001. Do not sen

this office. Instead, see Where To File on page 

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.

Include the suite, room, or other unit number after the street

address. If mail is not delivered to the street address and the

corporation has a P.O. box, enter the box number instead of the

street address.

You are not required to provide the informa

form or its instructions that is subject to the P

Reduction Act unless the form displays a valid 

number. Books and records relating to a form 

must be retained as long as their content may 

in the administration of any Internal Revenue l

returns and return information are confidential

section 6103.

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 a liquidation of

a subsidiary and to a distribution that is made according to a

plan of reorganization.

Address

Paperwork Reduction Act Notic

Signature

Form 966 (Rev. 4-2004) 

Line 10

Identify the code section under which the corporation is to be

dissolved or liquidated. For example, enter “section 331” for a

complete or partial liquidation of a corporation or enter “section

332” for a complete liquidation of a subsidiary corporation that

meets the requirements of section 332(b).