Form 1128 Application To Adopt, Change, Or Retain A Tax Year
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41128
Application To Adopt, Change, or Retain a Tax Year
Form
OMB No. 1545-0134
(Rev. April 1996)
Instructions are separate.
Department of the Treasury
Internal Revenue Service
Part I
General Information (All applicants complete this part. See page 4 for required signature(s). Also see page
2 of the instructions.)
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
/
(
)
(
)
Name of person to contact (If not the applicant, attach a power of attorney.)
Contact person’s area code and telephone number/Fax number
/
(
)
(
)
Check the appropriate box to indicate who is filing this form.
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Individual
Personal Service Corporation
Specified Foreign Corporation (Sec. 898)
Partnership
Cooperative (Sec. 1381(a))
Passive Foreign Investment Company (Sec. 1296)
Estate
Possession Corporation (Sec. 936)
Other Foreign Corporation
Corporation
Tax-Exempt Organization
Controlled Foreign Corporation (Sec. 957)
Other
S Corporation
Foreign Personal Holding Company (Sec. 552)
(Specify entity and applicable Code section)
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
.
3
Is the applicant using the same tax year for both Federal income tax and financial reporting purposes?
Yes
No
4
Indicate the applicant’s present overall method of accounting.
Cash receipts and disbursements method
Accrual method
Other method (specify)
5
State the nature of the applicant’s business or principal source of income.
6
Is Form 2848, Power of Attorney and Declaration of Representative, attached to this application?
Yes
No
7
Does the applicant request a conference of right at the IRS National Office? (See page 2 of the
instructions.)
Yes
No
8
Enter amount of user fee attached to this application. (See page 2 of the instructions.)
$
1128
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 21115C
Form
(Rev. 4-96)
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