Transcription of Form 1122 (Rev. December 2003) - Internal Revenue Service
1 Authorization and Consent of subsidiary CorporationTo Be Included in a Consolidated Income Tax Return1122 form (Rev. December 2003 )Department of the TreasuryInternal Revenue ServiceFor the calendar year 20, or other tax year beginning , 20and ending, 20 NameEmployer identification numberNumber, street, and room or suite or town, state, and ZIP codeName of parent corporationEmployer identification numberThe subsidiary corporation named above authorizes its parentcorporation to include it in a consolidated return for the tax yearindicated and for each subsequent year the group must file aconsolidated return under the applicable regulations. If theparent corporation does not file a consolidated return onUnder penalties of perjury, I declare that the subsidiary named above has authorized me to sign this form on its behalf, that I have examined thisform and the information contained herein, and to the best of my knowledge and belief, it is true, correct, and of subsidiary officerForm 1122 (Rev.)
2 12- 2003 ) SignHereThe subsidiary consents to be bound by the provisions ofthe consolidated return of the subsidiary , the subsidiary authorizes theCommissioner of the Internal Revenue Service or an IRSofficial to do No. 17228S Attach to the consolidated income tax for the subsidiary corporation. Complete andsubmit an original, signed form 1122 to the common parentcorporation of the consolidated group for the first tax year thesubsidiary consents to be included in the group s consolidatedincome tax for the parent corporation filing theconsolidated return. The common parent corporation of aconsolidated group must attach a separate form 1122 to thegroup s consolidated income tax return for each subsidiarycorporation for the first tax year each subsidiary consents tobe included in the consolidated return. Attach to theconsolidated return either the signed form 1122 or anunsigned version containing the same information stated onthe signed form .
3 If the parent corporation submits anunsigned form 1122 , it must retain the original, signed formin its records.
