Form 973 Corporation Claim for Deduction

for Consent Dividends

(Rev. December 2000) OMB No. 1545-0044

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. 12-2000)
Form 973 (Rev. 12-2000) 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.)

Signature

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

of my knowledge and belief, it is true, correct, and complete.

Signature of officer Date Title

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 4 hr., 4 min.

Learning about the law or the form 30 min.

Preparing and sending the form to the IRS 35 min.

  

The time needed to complete and file this form will vary depending

on individual circumstances. The estimated average time is:

Signature. Form 973 must be signed by the president, vice

president, treasurer, assistant treasurer, chief accounting officer, or

other corporate officer (such as tax officer) authorized to sign.

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.

When and where to file. Attach Form 973 to the corporation’s

income tax return for the tax year the consent dividend deduction is

claimed. Also attach a completed Form 972, Consent of Shareholder

To Include Specific Amount in Gross Income, for each shareholder

who agreed to treat the consent dividend as a taxable dividend.

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). File Form 1042,

Annual Withholding Tax Return for U.S. Source Income of Foreign

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

Subject to Withholding, to report the tax withheld. 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.