Corporation Application for Tentative Refund 
Form    1139                          ▶  Go to www.irs.gov/Form1139 for instructions and the latest information.                               OMB No. 1545-0123
(Rev. October 2018)
Department of the Treasury                ▶ Do not file with the corporation’s income tax return—file separately. 
Internal Revenue Service                         ▶ Keep a copy of this application for your records. 
Name                                                                                                         Employer identification number

Number, street, and room or suite no. If a P.O. box, see instructions.                                       Date of incorporation

City or town, state, and ZIP code                                                                            Daytime phone number

1       Reason(s) for filing.                                                                                c  Unused general  
        See instructions—             a   Net operating loss (NOL) .     .  ▶ $                                 business credit  ▶   $ 
        attach computation            b   Net capital loss   .   .     . .  ▶ $                              d  Other     .    .  ▶  $ 
2       Return for year of loss, unused credit, or        a  Tax year ended       b  Date tax return filed   c  Service center where filed 
        overpayment under section 1341(b)(1)  ▶
3       If this application is for an unused credit created by another carryback, enter ending date for the tax year of the first carryback ▶
4       Did a loss result in the release of a foreign tax credit, or is the corporation carrying back a general business credit that 
        was released because of the release of a foreign tax credit (see instructions)? If “Yes,” the corporation must file an 
        amended return to carry back the released credits  .           . .  . .   .  .      . .    . . .     . .    .   . .    .  .  .            Yes      No
5a      Was a consolidated return filed for any carryback year or did the corporation join a consolidated group (see instructions)?               Yes      No
b       If “Yes,” enter the tax year ending date and the name of the common parent and its EIN, if different from above (see instructions) ▶

6a      If Form 1138 has been filed, was an extension of time granted for filing the return for the tax year of the NOL?          .  .            Yes      No
b       If “Yes,” enter the date to which extension was granted  ▶                     c  Enter the date Form 1138 was filed .  ▶
d       Unpaid tax for which Form 1138 is in effect  .       .   .     . .  . .   .  .      . .    . . .     . .    .   . .    .  .  ▶       $ 
7       If the corporation changed its accounting period, enter the date permission to change was granted .             . .    .  .  ▶
8       If this is an application for a dissolved corporation, enter date of dissolution .    .    . . .     . .    .   . .    .  .  ▶
9       Has the corporation filed a petition in Tax Court for the year or years to which the carryback is to be applied? .        .  .            Yes      No
10      Is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be 
        disclosed? If “Yes,” attach Form 8886 .     .     .  .   .     . .  . .   .  .      . .    . . .     . .    .   . .    .  .  .            Yes      No
        Computation of Decrease in Tax                                        preceding                          preceding                            preceding 
                     See instructions.                      tax year ended ▶                  tax year ended ▶                   tax year ended ▶
Note:  If only filing for an unused general business         (a) Before          (b) After      (c) Before          (d) After     (e) Before           (f) After  
     credit (line 1c), skip lines 11 through 15.                carryback        carryback         carryback        carryback       carryback          carryback 
11      Taxable income from tax return .     . .    .
12      Capital loss carryback (see instructions)
13      Subtract line 12 from line 11 .    . . .    .
14      NOL deduction (see instructions)  .    .    .
15      Taxable income. Subtract line 14 from line 13
16      Income tax          . .   . .  .   . . .    .
17      Alternative minimum tax  .     .   . . .    .
18      Base erosion minimum tax (Attach Form 8991)
19      Add lines 16 through 18  .     .   . . .    .  
20      General business credit (see instructions) 
21      Other credits (see instructions)  .  . .    .    
22      Total credits. Add lines 20 and 21  .  .    .
23      Subtract line 22 from line 19 .    . . .    .
24      Personal holding company tax (Sch. PH (Form 1120))
25      Other taxes (see instructions)     . . .    .
26      Total tax liability. Add lines 23 through 25
27      Enter amount from “After carryback” 
        column on line 26 for each year .    . .    .
28      Decrease in tax. Subtract line 27 from line 26
29      Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)  .            .    .  .  .       .  .  
            Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Sign               ▲                                                                 ▲                              ▲
Here                 Signature of officer                                              Date                             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 Paperwork Reduction Act Notice, see separate instructions.                                  Cat. No. 11170F                              Form 1139 (Rev. 10-2018)