OMB No. 1545-0134 
Form  1128                                           Application To Adopt, Change, or Retain a Tax Year 
(Rev. October 2014) 
                                                                                                                                                       Attachment 
Department of the Treasury                         © Information about Form 1128 and its separate instructions is available at www.irs.gov/form1128.   Sequence No.  148
Internal Revenue Service 
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 

                            City or town, state, and ZIP code                                                        Filer’s area code and telephone number/Fax number 
                                                                                                                     (          )                    / (          )
              Type or Print 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                    Cooperative (sec. 1381(a))                              Passive foreign investment company (PFIC) 
                                Partnership                   Controlled foreign corporation (CFC) (sec. 957)         (sec. 1297) 
                                Estate                        Foreign sales corporation (FSC) or Interest-charge      Other foreign corporation 
                                Domestic corporation          domestic international sales corporation (IC-DISC)      Tax-exempt organization 
                                S corporation                 Specified foreign corporation (SFC) (sec. 898)          Homeowners Association (sec. 528) 
                                Personal service              10/50 corporation (sec. 904(d)(2)(E))                   Other 
                                corporation (PSC)             Trust                                                   (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.) 
                              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.
Sign                          ▲                                                                                      ▲
Here
                                Signature of filer                                                        Date        Type or print name and title
                                Print/Type preparer’s name          Preparer’s signature                              Date                                       PTIN
Paid                                                                                                                                            Check         if 
                                                                                                                                                self-employed
Preparer                                            ▶                                                                             Firm’s EIN  ▶
                                Firm’s name      
                                Firm’s address  
Use Only                                            ▶                                                                             Phone no.
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 
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)) 
                                                                                                                   Form  1128  (Rev. 10-2014) 

Form 1128 (Rev. 10-2014)                                                                                                        Page  4 
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)