RV-F1308301 (08/20)            
                            TENNESSEE DEPARTMENT OF REVENUE
                                       Consolidated Net Worth
                                      Election Registration Application

This application must be completed by affiliated groups and financial institution affiliated groups electing to compute 
the net worth base for franchise tax purposes on a consolidated basis.

Check all boxes that apply:

New election
Amended election to add or remove group members
Revoke election
Application is for a financial institution affiliated group

Effective Date of the Election: Start                    End (if revoking election)

FEIN                                                          Account Number

Secretary of State Control Number

Legal Name

Physical Location (no P.O. Box)
                                Street                        City                    State         ZIP Code

Mailing Address
                                Street                        City                    State         ZIP Code
Telephone Number                                         Email
Describe the group’s predominate business activity, stating the major products and/or services sold (affiliated group):

The statements made on this application are true to the best of my knowledge and            Mail to:
belief.  This application must be signed by the individual owner, a partner, or or an 
officer of the corporation.                                                           Tennessee Department of Revenue
                                                                                      Andrew Jackson State Office Building
                                                                                      500 Deaderick Street
Signature of owner, partner, officer  (do not use stamp)               Date           Nashville, Tennessee  37242

Part 1 - Affiliated group members or financial institution affiliated group members subject to Tennessee
franchise and excise tax

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name

Physical Location (no P.O. Box)
                               Street               City                 State             ZIP Code
Mailing Address
                               Street               City                 State             ZIP Code
Telephone Number                       Email

FEIN                    Account Number                                   SOS Control Number

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name

Physical Location (no P.O. Box)
                               Street               City                 State             ZIP Code
Mailing Address
                               Street               City                 State             ZIP Code
Telephone Number                       Email

FEIN                    Account Number                                   SOS Control Number

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name

Physical Location (no P.O. Box)
                               Street               City                 State             ZIP Code
Mailing Address
                               Street               City                 State             ZIP Code
Telephone Number                       Email

FEIN                    Account Number                                   SOS Control Number

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name

Physical Location (no P.O. Box)
                               Street               City                 State             ZIP Code
Mailing Address
                               Street               City                 State             ZIP Code
Telephone Number                       Email

FEIN                    Account Number                                   SOS Control Number

Part 2 - Affiliated group members or financial institution affiliated group members not subject to Tennessee 
franchise and excise tax

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name                                                               FEIN

Physical Location (no P.O. Box)
                               Street               City                 State ZIP Code

Mailing Address
                               Street               City                 State ZIP Code
Telephone Number                      Email

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name                                                               FEIN

Physical Location (no P.O. Box)
                               Street               City                 State ZIP Code

Mailing Address
                               Street               City                 State ZIP Code
Telephone Number                      Email

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name                                                               FEIN

Physical Location (no P.O. Box)
                               Street               City                 State ZIP Code

Mailing Address
                               Street               City                 State ZIP Code
Telephone Number                      Email

Check if amended: New member          Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name                                                               FEIN

Physical Location (no P.O. Box)
                               Street               City                 State ZIP Code

Mailing Address
                               Street               City                 State ZIP Code
Telephone Number                      Email

        Instructions: Consolidated Net Worth Election Registration Application 

Members of an affiliated group or a financial institution affiliated group may make a group election to compute 
their net worth base for franchise tax purposes on a consolidated basis.  An affiliated group is comprised of the 
following: 1) a taxpayer that, standing alone, is subject to Tennessee franchise tax; 2) all other domestic persons in 
which the taxpayer, directly or indirectly, has more than a 50% ownership interest; 3) all other domestic persons 
that, directly or indirectly, have more than a 50% ownership interest in a taxpayer; and 4) all other domestic persons 
in which a person described in (3) above, directly or indirectly, has more than a 50% ownership interest, regardless 
of whether such persons do business in Tennessee. A domestic person means any person with more than 20% of 
the average of its property, payroll, and receipts factors in the United States (Tenn. Code Ann. §§ 67-4-2004 and 67-
4-2103).

This election must be made on or before the due date of the tax return for the period for which the election is to 
take effect. This election form is not  for filing a combined return. Combined returns can only be filed by financial 
institutions that are members of a unitary group.

This election is a group election.  All affiliates, as defined in Tenn. Code Ann. § 67-4-2004(1), are bound by the 
election and must compute their net worth franchise tax base, reflected on their separate-entity franchise and 
excise tax returns, on a consolidated basis.  The election remains in effect for a minimum of five tax years, and it 
continues to remain in effect until revoked.  An amended registration form should be filed annually if a member of 
the group enters or leaves the group at any time during the tax year.

This election is not allowed unless each member of the group closes its taxable year on the same date.  However, 
the election is permitted when a member exits the group during the taxable year because of a change in ownership, 
merger, or liquidation of the member.  When this happens, the member exiting the group is excluded from the 
group and computes its net worth on an unconsolidated basis.

This application must be signed and dated at the bottom of the first page by the owner, partner, or officer, and it 
must be mailed to the address indicated.  Do not attach to your franchise and excise tax return.