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CBT-2553 State of New Jersey
(8-05) Division of Taxation
New Jersey S Corporation or New Jersey QSSS Election
Check the appropriate box:
Initial S Corporation Election
New Jersey QSSS Election (See Part V)
Change in S or QSSS Corporation Shareholders
IMPORTANT: This form only has to be filed once. There is no renewal required. Please Note: All changes can be filed with the S corporation final return.
Part I Corporate Information (Type or Print)
Name of Corporation Federal Employer Identification Number
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Mailing Address New Jersey Corporation Number
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City or Town, State and ZIP Code Name and telephone number of corporate officer or legal representative
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Date of Incorporation State of Incorporation
Check here
if the corporation has changed its name or address in the past 12 months //
Election Information
Enter the effective date of the Federal S corporation election ________/________/________ Applied for
month day year
New Jersey S corporation or New Jersey QSSS election is to be effective for tax year beginning _______/_______/_______ ending _______/_______/_______
month day year month day year
NOTE: If this election takes effect for the first tax year the corporation exists, enter for item 2 and item 3, the month, day and year of the earliest of the following:
(1) date the corporation first had shareholders, (2) date the corporation first had assets, or (3) date the corporation began doing business.
If the accounting period you enter is for an automatic 52-53 week tax year, check here
Part II Shareholder’s Consent Statement - By signing this election, we the undersigned shareholders, consent (1) to the corporation’s election to be
treated as a New Jersey S corporation under N.J.S.A. 54:10A-1, et seq., (2) that New Jersey shall have the right and jurisdiction to tax and collect the
tax on each shareholder’s S corporation income, as defined in N.J.S.A. 54A:5-10 and (3) such right and jurisdiction shall not be affected by a change
of a shareholder’s residency, except as provided in N.J.S.A. 54A:1-1, et seq. Shareholders must sign, date and provide the requested information
below. For the original or initial election to be valid, the consent of each shareholder, person having a community property interest in the corporation’s
stock, and each tenant in common, joint tenant, and tenant by the entirety must appear below or be attached to this form. If more space is needed, a
continuation sheet reporting the exact information for additional shareholders or a second consent statement must be attached to this form.
community property interest in the corporation’s or holder’s
Name of each shareholder, person having a *** Signatures must be provided *** Stock Owned Social Security Number * Share-
stock, and each tenant in common, joint tenant, and Number Dates Employer Identification Number state of
tenant by the entirety. (A husband and wife (and Signature Date of acquired for an estate or qualified trust residency
their estates) are counted as one shareholder). shares
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* You must provide the address of any shareholder who is not a resident of New Jersey on a rider and attach it to this form.
Part III Corporation’s Consent Statement - The above named corporation consents (1) to the election to be treated as a New Jersey S corporation under
N.J.S.A. 54:10A-1, et seq., (2) to fulfill any tax obligations of any nonconsenting shareholder who was not an initial shareholder as required by any tax
law in the State of New Jersey including the payment of tax to the State of New Jersey on behalf of such shareholder. (An authorized officer must sign
and date below.)
Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete.
____________________________________________________________________________________________________________________________X
Signature of authorized officer Title Date
Do not enter any shareholder who sold or transferred all of his or her stock
Part IV Persons who are no longer shareholders of the corporation. before the election was made.
Name of shareholder, person no longer having a community Social Security Number
property interest in the corporation’s stock, tenant in common, Date or
joint tenant, or tenant by the entirety. (A husband and wife Stock Relinquished Employer Identification Number
(and their estates) are counted as one shareholder). for an estate or qualified trust
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Under penalties of perjury, I declare that the above, to the best of my knowledge and belief, is true, correct, and complete.
_______________________________________________________________________________________________________________________________
Signature of authorized officer Title Date
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