The IRS Form 604 551 is a Request for Withdrawal of Election by an S Corporation. When an election is made to have an s-corporation, the corporation must continue to be treated as such until the election is terminated. This form is usually used to terminate the election when a change in ownership or structure would prevent the company from meeting the qualifications for an S Corporation. By filing this form, you are notifying the IRS that you would like to have your S-Corp status terminated. There can be tax implications associated with withdrawing your election so it is important to speak with a tax professional before making any decisions. This form can be used in a few different situations: 1) The company has changed their ownership structure and no longer qualifies as an S-Corp; 2) The company has changed their management structure and no longer meets requirements for single owner/member management; 3) The company has reached 199 shareholders (this number includes employees
| Question | Answer |
|---|---|
| Form Name | Form 604 551 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 2012, Caries, 1ST, head start dental exam form |
Head Start - State Preschool
DENTAL EXAM FORM
PROGRAM CHILD IS ENROLLED IN
Head Start |
Early Head Start |
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Center Base |
Home Base |
FCC |
LAST NAME, FIRST NAME, MIDDLE INITIAL OF CHILD
SEX
M
F
DATE OF BIRTH
NAME OF PARENT OR GUARDIAN
DELEGATE AGENCY NAME/SITE
TO BE COMPLETED BY DENTIST
(THIS IS NOT A BILLING FORM)
DENTAL EXAMINATION ADMINISTERED BY (TYPE OR PRINT NAME)
SIGNATURETELEPHONE NUMBER
ADDRESS
DENTAL SERVICES PROVIDED
Dental Examination
Yes
No |
Date of Exam |
Preventive Dental Care Provided (including Fluoride &/or Anticipatory Guidance)
Yes
No
DESCRIBE PREVENTIVE CARE
DENTAL DIAGNOSIS
Normal Examination/No Treatment Needed Dental Treatment Needed
Dental Diagnosis: |
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Cavities |
Number of Cavities |
Other Diagnosis
Early Childhood Caries (ECC)
DENTAL TREATMENT
Dental Treatment Initiated |
Yes |
No |
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Describe Dental Treatment |
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Has all Dental Treatment Been Completed? |
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Yes |
No |
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Date of Next Visit for Treatment |
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NEXT DENTAL EXAMINATION |
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Date Next Routine Dental Examination Due |
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TO BE COMPLETED BY HEAD START STAFF |
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SIGNATURE OF STAFF COMPLETING 1ST REVIEW |
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POSITION |
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DATE |
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SIGNATURE OF STAFF COMPLETING 2ND REVIEW |
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POSITION |
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DATE |
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HEAD START |
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REFERRED FOR
Nutrition
Other
INITIALS/DATE FORM RECEIVED
FORM NO.