Corporation Application for Tentative Refund 
Form    1139                  ▶  Information about Form 1139 and its separate instructions is at www.irs.gov/form1139.                           OMB No. 1545-0123
(Rev. November 2014)                    ▶ Do not file with the corporation’s income tax return—file separately. 
Department of the Treasury                         ▶ Keep a copy of this application for your records. 
Internal Revenue Service 
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      Add lines 16 and 17  .      . .  .  .    .  .  
19      General business credit (see instructions) 
20      Other credits (see instructions)  . .    .  .    
21      Total credits. Add lines 19 and 20  .    .  .
22      Subtract line 21 from line 18 .  .  .    .  .
23      Personal holding company tax (Sch. PH (Form 1120))
24      Other taxes (see instructions)   .  .    .  .
25      Total tax liability. Add lines 22 through 24
26      Enter  amount  from  “After  carryback”  
        column on line 25 for each year .   .    .  .
27      Decrease in tax. Subtract line 26 from line 25
28      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 
Use Only Firm’s name      ▶                                                                                             Firm's EIN  ▶
         Firm's address  ▶                                                                                              Phone no.
For Paperwork Reduction Act Notice, see separate instructions.                                  Cat. No. 11170F                              Form 1139 (Rev. 11-2014)