Form 1122                            Authorization and Consent of Subsidiary Corporation
(Rev. December 2003)                 To Be Included in a Consolidated Income Tax Return
Department of the Treasury                   
                 Attach to the consolidated income tax return.
Internal Revenue Service

For the calendar year 20         , or other tax year beginning                   , 20 and ending                                        , 20
Name                                                                                             Employer identification number

Number, street, and room or suite no.

City or town, state, and ZIP code

Name of parent corporation                                                                       Employer identification number

The subsidiary corporation named above authorizes its parent        behalf of the subsidiary, the subsidiary authorizes the
corporation to include it in a consolidated return for the tax year Commissioner of the Internal Revenue Service or an IRS
indicated and for each subsequent year the group must file a        official to do so.
consolidated return under the applicable regulations. If the          The subsidiary consents to be bound by the provisions of
parent corporation does not file a consolidated return on           the consolidated return regulations.
     Under penalties of perjury, I declare that the subsidiary named above has authorized me to sign this form on its behalf, that I have examined this
     form and the information contained herein, and to the best of my knowledge and belief, it is true, correct, and complete.
Sign
Here
     
 Signature of subsidiary officer                           Date                 
 Title
Instructions for the subsidiary corporation. Complete and           corporation for the first tax year each subsidiary consents to
submit an original, signed Form 1122 to the common parent           be included in the consolidated return. Attach to the
corporation of the consolidated group for the first tax year the    consolidated return either the signed Form 1122 or an
subsidiary consents to be included in the group’s consolidated      unsigned version containing the same information stated on
income tax return.                                                  the signed form. If the parent corporation submits an
Instructions for the parent corporation filing the                  unsigned Form 1122, it must retain the original, signed form
consolidated return. The common parent corporation of a             in its records.
consolidated group must attach a separate Form 1122 to the
group’s consolidated income tax return for each subsidiary

                                                                Cat. No. 17228S                                               Form 1122 (Rev. 12-2003)