Fillable Form 966 - 2004 Corporate Dissolution Or Liquidation printable pdf download

966

Corporate Dissolution or Liquidation

Form

OMB No. 1545-0041

(Rev. April 2004)

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

Department of the Treasury

Internal Revenue Service

Name of corporation

Employer identification number

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

Check type of return

1120

1120-L

City or town, state, and ZIP code

1120-IC-DISC

1120S

Other

Date incorporated

Place incorporated

Type of liquidation

Date resolution or plan of complete

or partial liquidation was adopted

Complete

Partial

Service Center where corporation filed

Last month, day, and year of

Was corporation’s final tax return

its immediately preceding tax return

immediately preceding tax year

final tax year

filed as part of a consolidated

income tax return? If “Yes,”

complete 7c, 7d, and 7e.

Yes

Name of common parent

Employer identification number

Service Center where

of common parent

consolidated return was filed

Common

Preferred

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

Date(s) of any amendments to plan of dissolution

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

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 previously filed.

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

it is true, correct, and complete.

Signature of officer

Title

Date

Instructions

Where To File

File Form 966 with the Internal Revenue Service Center at the

Who Must File

applicable address shown below:

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

The address

Cooperative Association Income Tax Return) must file Form 966

For . . .

is . . .

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

Corporations filing Form 1120-F, or

liquidate any of its stock. Exempt organizations and qualified

1120-FSC; corporations whose principal

subchapter S subsidiaries are not required to file Form 966.

business, office, or agency is located in a

These organizations should see the instructions for Form 990,

Philadelphia, PA

foreign country or U.S. possession; and

Return of Organization Exempt from Income Tax or Form

19255

corporations claiming the possessions

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

corporation tax credit under sections 30A

Nonexempt Charitable Trust Treated as a Private Foundation and

and 936

Form 8869, Qualified Subchapter S Subsidiary Election,

respectively.

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

corporations (not listed above, except

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

Form 1120-IC-DISC) whose total assets

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

at the end of the tax year are $10 million

disregarded entity under Regulations section 301.7701-3).

or more or whose principal business,

When To File

office, or agency is located in Alabama,

Ogden, UT

Alaska, Arizona, Arkansas, California,

84201

File Form 966 within 30 days after the resolution or plan is

Colorado, Florida, Georgia, Hawaii, Idaho,

adopted to dissolve the corporation or liquidate any of its stock.

Iowa, Kansas, Louisiana, Minnesota,

Mississippi, Missouri, Montana,

If the resolution or plan is amended or supplemented after Form

Nebraska, Nevada, New Mexico, North

966 is filed, file another Form 966 within 30 days after the

Dakota, Oklahoma, Oregon, South

amendment or supplement is adopted. The additional form will

Dakota, Tennessee, Texas, Utah,

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

Washington, or Wyoming

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

attached. Include all information required by Form 966 that was

All other corporations not listed above.

Cincinnati, OH

not given in the earlier form.

45999

966

Cat. No. 17053B

Form

(Rev. 4-2004)

Form 966 - 2004 Corporate Dissolution Or Liquidation

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