California Form 1117 Draft - Request To Terminate Water'S-Edge Election - 2010 Page 2

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TAXABLE YEAR
CALIFORNIA FORM
20
Request to Terminate Water’s-Edge Election
1117
Fill out the form completely. Do not change the method of filing until the Franchise Tax Board has approved this request.
Corporation name (as shown on original water’s-edge return)
Key California corporation number
Address (suite, room, or PMB no.)
City
State
ZIP Code
Part I  Effective Dates
Enter the taxable year ending date that the request to terminate the water’s-edge election will be effective: . . . . . . . . . . . . . . . . . .
/
/
Month
Day
Year
Enter the beginning date of the water’s-edge election: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
/
/
Month
Day
Year
Part II Basis to Terminate Water’s-Edge Election. See Instructions .
Explain the basis for the request to terminate the water’s-edge election . Attach additional sheets if necessary .
Part III List of Taxpayers Requesting to Terminate Water’s-Edge Election. Attach additional sheets if necessary .
Taxpayer’s name
California corporation number
FEIN
Part IV Gains and Losses. See General Information F, Gains and Losses . Attach additional sheets if necessary .
Corporation name
Item disposed of
Date sold/disposed of
Gain/loss
Signature
I attest to the belief that the water’s-edge termination is permitted by law and to the accuracy of factual statements .
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge,
it is true, correct, and complete .
____________________________________________________ ______________________________________ _________________
Signature of officer
Title
Date
_______________________________________________________________ _(_________)___________________________________
Print or type name of person to contact
Telephone
THIS FORM MUST BE FILED SEPARATELY FROM THE TAX RETURN
FTB 1117
2010
7191103
C1

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