Form 1128 – Fill Out and Use This PDF

Part I		General Information
	Important: All filers must complete Part I and sign below. See instructions.
	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
Print
	City or town, state, and ZIP code			Filer’s area code and telephone number/Fax number
or
			(	)		(	)
Type					/
	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
			(	)	/	(	)

1Check the appropriate box(es) to indicate the type of applicant (see instructions).

2a 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 ▶

bIf changing a tax year, indicate the date the present tax year ends (see instructions). ▶

cIf 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.

4Indicate the applicant’s present overall method of accounting.

Cash receipts and disbursements method

Accrual method

Other method (specify) ▶

5State the nature of the applicant’s business or principal source of income.

Signature—All Filers (See Who Must Sign in the instructions.)

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 21115C

Form 1128 (Rev. 10-2014)

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

1Is 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

2Does 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.

3Is 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)

4Is 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) . . . . ▶

5Is 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? . ▶

6Is 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)

9Is 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)

10Is 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

1Is 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.

2Has 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.

3Within the most recent 48-month period, has any accounting period application been withdrawn, not perfected,

denied, or not implemented? . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ If “Yes,” attach an explanation.

4a 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).

bIf 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)

5Enter 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	$		$

7Enter 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) . . . . . . . . . . . . . . . . . ▶	$
8a	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.
9a	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.

bDid the applicant elect under section 1295 to treat the PFIC as a qualified electing fund? . . . . . . . ▶

10a 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? . . . . . . . . . . . . . ▶

11Does 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.

12Is Form 2848, Power of Attorney and Declaration of Representative, attached to this application? . . . . ▶

13Does 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)

15Enter the date of incorporation. ▶

Yes No

16a	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.

bIf 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))

Form 1128 (Rev. 10-2014)