Note: Form 1128 begins on the next page.
The “Where to File” mailing address for a ruling request for exempt organizations
has changed.
The filing address included in the instructions for Part III of Form 1128 (Rev. October
2014) for exempt organizations requesting a ruling has changed.
The new address is:
Internal Revenue Service
1973 N Rulon White Blvd M/S 6273
Ogden, Utah 84201
The new filing address is effective immediately.
Form 1128
(Rev. October 2014)
Department of the Treasury
Internal Revenue Service
Application To Adopt, Change, or Retain a Tax Year
Information about Form 1128 and its separate instructions is available at www.irs.gov/form1128.
OMB No. 1545-0134
Attachment
Sequence No. 148
Part I General Information
Important: All filers must complete Part I and sign below. See instructions.
Type or Print
Name of filer (if a joint return is filed, also enter spouse’s name) (see instructions)
Filer’s identifying number
Number, street, and room or suite no. (if a P.O. box, see instructions)
Service Center where income tax return will be filed
City or town, state, and ZIP code
Filer’s area code and telephone number/Fax number
( ) ( )
/
Name of applicant, if different than the filer (see instructions) Applicant’s identifying number (see instructions)
Name of person to contact (if not the applicant or filer, attach a power of attorney)
Contact person’s area code and telephone number/Fax number
( ) ( )
/
1 Check the appropriate box(es) to indicate the type of applicant (see instructions).
Individual
Partnership
Estate
Domestic corporation
S corporation
Personal service
corporation (PSC)
Cooperative (sec. 1381(a))
Controlled foreign corporation (CFC) (sec. 957)
Foreign sales corporation (FSC) or Interest-charge
domestic international sales corporation (IC-DISC)
Specified foreign corporation (SFC) (sec. 898)
10/50 corporation (sec. 904(d)(2)(E))
Trust
Passive foreign investment company (PFIC)
(sec. 1297)
Other foreign corporation
Tax-exempt organization
Homeowners Association (sec. 528)
Other
(Specify entity and applicable Code section)
2 a Approval is requested to (check one) (see instructions):
Adopt a tax year ending
(Partnerships and PSCs: 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 (see instructions).
c If adopting or changing a tax year, the first return or short period return will be filed for the tax year
beginning
, 20 , and ending , 20
3 Is the applicant’s present tax year, as stated on line 2b above, also its current financial reporting year?
Yes No
If “No,” attach an explanation.
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.
Signature—All Filers (See Who Must Sign in the instructions.)
Sign
Here
Under penalties of perjury, I declare that I have examined this application, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than filer) is based on all information of which preparer has any knowledge.
Signature of filer
Date
Type or print name and title
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm’s EIN
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 21115C
Form
1128 (Rev. 10-2014)
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signature
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Form 1128 (Rev. 10-2014)
Page 2
Part II Automatic Approval Request (see instructions)
• Identify the revenue procedure under which this automatic approval request is filed
Section A—Corporations (Other Than S Corporations or Personal Service Corporations) (Rev. Proc. 2006-45, or its successor)
Yes No
1 Is the applicant a corporation (including a homeowners association (section 528)) that is requesting a change in
tax year and is allowed to use the automatic approval rules under section 4 of Rev. Proc. 2006-45 (or its
successor)? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Does the corporation intend to elect to be an S corporation for the tax year immediately following the short period?
If “Yes” and the corporation is electing to change to a permitted tax year, file Form 1128 as an attachment to Form
2553.
3
Is the applicant a corporation requesting a concurrent change for a CFC, FSC or IC-DISC? (see instructions) .
Section B—Partnerships, S Corporations, Personal Service Corporations (PSCs), and Trusts (Rev. Proc. 2006-46, or
its successor)
4
Is the applicant a partnership, S corporation, PSC, or trust that is requesting a tax year and is allowed to use the
automatic approval rules under section 4 of Rev. Proc. 2006-46 (or its successor)? (see instructions) . . . .
5 Is the partnership, S corporation, PSC, or trust requesting to change to its required tax year or a partnership, S
corporation, or PSC that wants to change to a 52-53 week tax year ending with reference to such tax year? .
6 Is the partnership, S corporation, or PSC (other than a member of a tiered structure) requesting a tax year that
coincides with its natural business year described in section 4.01(2) of Rev. Proc. 2006-46 (or its successor)?
Attach a statement showing gross receipts for the most recent 47 months. (See instructions for information
required to be submitted) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Is the S corporation requesting an ownership tax year? (see instructions) . . . . . . . . . . . . .
8 Is the applicant a partnership requesting a concurrent change pursuant to section 6.09 of Rev. Proc. 2006-45
(or its successor) or section 5.04(8) of Rev. Proc. 2002-39 (or its successor)? (see instructions) . . . . .
Section C—Individuals (Rev. Proc. 2003-62, or its successor) (see instructions)
9
Is the applicant an individual requesting a change from a fiscal year to a calendar year? . . . . . . . .
Section D—Tax-Exempt Organizations (Rev. Proc. 76-10 or 85-58) (see instructions)
10
Is the applicant a tax-exempt organization requesting a change? . . . . . . . . . . . . . . .
Part III
Ruling Request (All applicants requesting a ruling must complete Section A and any other section that
applies to the entity. See instructions.) (Rev. Proc. 2002-39, or its successor)
Section A—General Information
Yes No
1 Is the applicant a partnership, S corporation, personal service corporation, or trust that is under examination by
the IRS, before an appeals office, or a Federal court? . . . . . . . . . . . . . . . . . . .
If “Yes,” see the instructions for information that must be included on an attached explanation.
2 Has the applicant changed its annual accounting period at any time within the most recent 48-month period
ending with the last month of the requested tax year? . . . . . . . . . . . . . . . . . . .
If “Yes” and a letter ruling was issued granting approval to make the change, attach a copy of the letter ruling, or if
not available, an explanation including the date approval was granted. If a letter ruling was not issued, indicate
when and explain how the change was implemented.
3 Within the most recent 48-month period, has any accounting period application been withdrawn, not perfected,
denied, or not implemented? . . . . . . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” attach an explanation.
4 a Is the applicant requesting to establish a business purpose under section 5.02(1) of Rev. Proc. 2002-39 (or its
successor)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” attach an explanation of the legal basis supporting the requested tax year (see instructions).
b If your business purpose is based on one of the natural business year tests under section 5.03, check the
applicable box.
Annual business cycle test Seasonal business test 25-percent gross receipts test
Attach a statement showing gross receipts from sales and services (and inventory cost if applicable) for the test
period. (see instructions)
5 Enter the taxable income or (loss) for the 3 tax years immediately preceding the year of change and for the short
period. If necessary, estimate the amount for the short period.
Short period
$
First preceding year
$
Second preceding year
$
Third preceding year
$
Note: Individuals, enter adjusted gross income. Partnerships and S corporations, enter ordinary income. Section
501(c) organizations, enter unrelated business taxable income. Estates, enter adjusted total income. All other
applicants, enter taxable income before net operating loss deduction and special deductions.
Form 1128 (Rev. 10-2014)
Form 1128 (Rev. 10-2014)
Page 3
6 Corporations only, enter the losses or credits, if any, that were generated or that expired in the short period:
Yes No
Generated Expiring
Net operating loss . . . . . . . .
$ $
Capital loss . . . . . . . . . .
$ $
Unused credits . . . . . . . . .
$ $
7 Enter the amount of deferral, if any, resulting from the change (see section 5.05(1), (2), (3) and 6.01(7) of
Rev. Proc. 2002-39, or its successor) . . . . . . . . . . . . . . . . .
$
8 a Is the applicant a U.S. shareholder in a CFC? . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” attach a statement for each CFC providing the name, address, identifying number, tax year, the
percentage of total combined voting power of the applicant, and the amount of income included in the gross
income of the applicant under section 951 for the 3 tax years immediately before the short period and for the
short period.
b Will each CFC concurrently change its tax year? . . . . . . . . . . . . . . . . . . . . .
If “Yes” to line 8b, go to Part II, line 3.
If “No,” attach a statement explaining why the CFC will not be conforming to the tax year requested by the U.S.
shareholder.
9 a Is the applicant a U.S. shareholder in a PFIC as defined in section 1297? . . . . . . . . . . . . .
If “Yes,” attach a statement providing the name, address, identifying number, and tax year of the PFIC, the
percentage of interest owned by the applicant, and the amount of distributions or ordinary earnings and net
capital gain from the PFIC included in the income of the applicant.
b
Did the applicant elect under section 1295 to treat the PFIC as a qualified electing fund? . . . . . . .
10 a Is the applicant a member of a partnership, a beneficiary of a trust or estate, a shareholder of an S corporation, a
shareholder of an IC-DISC, or a shareholder of an FSC? . . . . . . . . . . . . . . . . . .
If “Yes,” attach a statement providing the name, address, identifying number, type of entity (partnership, trust,
estate, S corporation, IC-DISC, or FSC), tax year, percentage of interest in capital and profits, or percentage of
interest of each IC-DISC or FSC and the amount of income received from each entity for the first preceding year
and for the short period. Indicate the percentage of gross income of the applicant represented by each amount.
b Will any partnership concurrently change its tax year to conform with the tax year requested? . . . . . .
c If “Yes” to line 10b, has any Form 1128 been filed for such partnership? . . . . . . . . . . . . .
11 Does the applicant or any related entity currently have any accounting method, tax year, ruling, or technical
advice request pending with the IRS National Office? . . . . . . . . . . . . . . . . . . .
If “Yes,” attach a statement explaining the type of request (method, tax year, etc.) and the specific issues involved
in each request.
12
Is Form 2848, Power of Attorney and Declaration of Representative, attached to this application? . . . .
13
Does the applicant request a conference of right (in person or by telephone) with the IRS National Office, if the
IRS proposes to disapprove the application? . . . . . . . . . . . . . . . . . . . . . .
14
Enter amount of user fee attached to this application (see instructions) . . . . . . . . . .
$
Section B—Corporations (other than S corporations and controlled foreign corporations) (see instructions)
15
Enter the date of incorporation.
Yes No
16 a Does the corporation intend to elect to be an S corporation for the tax year immediately following the short
period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b If “Yes,” will the corporation be going to a permitted S corporation tax year? . . . . . . . . . . .
If “No” to line 16b, attach an explanation.
17 Is the corporation a member of an affiliated group filing a consolidated return? . . . . . . . . . . .
If “Yes,” attach a statement providing (a) the name, address, identifiying number used on the consolidated return,
tax year, and Service Center where the applicant files the return; (b) the name, address, and identifying number of
each member of the affiliated group; (c) the taxable income (loss) of each member for the 3 years immediately
before the short period and for the short period; and (d) the name of the parent corporation.
18a Personal service corporations (PSCs): Attach a statement providing each shareholder’s name, type of entity
(individual, partnership, corporation, etc.), address, identifying number, tax year, percentage of ownership, and
amount of income received from the PSC for the first preceding year and the short period.
b If the PSC is using a tax year other than the required tax year, indicate how it obtained its tax year.
Grandfathered (attach copy of letter ruling) Section 444 election (date of election
)
Letter ruling (date of letter ruling
(attach copy))
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Section C—S Corporations (see instructions)
19
Enter the date of the S corporation election.
Yes No
20 Is any shareholder applying for a corresponding change in tax year? . . . . . . . . . . . . . .
If “Yes,” each shareholder requesting a corresponding change in tax year must file a separate Form 1128 to get
advance approval to change its tax year.
21 If the corporation is using a tax year other than the required tax year, indicate how it obtained its tax year.
Grandfathered (attach copy of letter ruling) Section 444 election (date of election
)
Letter ruling (date of letter ruling (attach copy))
22
Attach a statement providing each shareholder’s name, type of shareholder (individual, estate, qualified
subchapter S Trust, electing small business trust, other trust, or exempt organization), address, identifying
number, tax year, percentage of ownership, and the amount of income each shareholder received from the S
corporation for the first preceding year and for the short period.
Section D—Partnerships (see instructions)
23
Enter the date the partnership’s business began.
Yes No
24
Is any partner applying for a corresponding change in tax year? . . . . . . . . . . . . . . . .
25
Attach a statement providing each partner’s name, type of partner (individual, partnership, estate, trust,
corporation, S corporation, IC-DISC, etc.), address, identifying number, tax year, and the percentage of interest in
capital and profits.
26 Is any partner a shareholder of a PSC as defined in Regulations section 1.441-3(c)? . . . . . . . . .
If “Yes,” attach a statement providing the name, address, identifiying number, tax year, percentage of interest in
capital and profits, and the amount of income received from each PSC for the first preceding year and for the
short period.
27
If the partnership is using a tax year other than the required tax year, indicate how it obtained its tax year.
Grandfathered (attach copy of letter ruling) Section 444 election (date of election
)
Letter ruling (date of letter ruling (attach copy))
Section E—Controlled Foreign Corporations (CFC)
28
Attach a statement for each U.S. shareholder (as defined in section 951(b)) providing the name, address,
identifying number, tax year, percentage of total value and percentage of total voting power, and the amount of
income included in gross income under section 951 for the 3 tax years immediately before the short period and
for the short period.
Section F—Tax-Exempt Organizations
29
Type of organization:
Corporation
Trust
Other (specify)
Yes No
30
Date of organization.
31
Code section under which the organization is exempt.
32
Is the organization required to file an annual return on Form 990, 1120-C, 990-PF, 990-T, 1120-H, or 1120-POL?
33
Enter the date the tax exemption was granted.
. Attach a copy of the letter ruling granting
exemption. If a copy of the letter ruling is not available, attach an explanation.
34
If the organization is a private foundation, is the foundation terminating its status under section 507? . . .
Section G—Estates
35
Enter the date the estate was created.
36 a Attach a statement providing the name, identifying number, address, and tax year of each beneficiary and each person who is
an interested party of any portion of the estate.
b Based on the adjusted total income of the estate entered in Part III, Section A, line 5, attach a statement showing the
distribution deduction and the taxable amounts distributed to each beneficiary for the 2 tax years immediately before the short
period and for the short period.
Section H—Passive Foreign Investment Companies
37 If the applicant is a passive foreign investment company, attach a statement providing each U.S. shareholder’s name, address,
identifying number, and percentage of interest owned.
Form 1128 (Rev. 10-2014)
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