1014 Form 1128 (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1128.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Note: Form 1128 begins on the next page.¶

The “Where to File” mailing address for a ruling request for exempt organizations has changed.

The filing address included in the instructions for Part III of Form 1128 (Rev. October 2014) for exempt organizations requesting a ruling has changed.

The new address is:

Internal Revenue Service 1973 N Rulon White Blvd M/S 6273 Ogden, Utah 84201

The new filing address is effective immediately.

Form

Exceptions & meaning →

1128¶

OMB No. 1545-0134

(Rev. October 2014) Department of the Treasury Internal Revenue Service

Exceptions & meaning →

Application To Adopt, Change, or Retain a Tax Year¶

Attachment

Department of the Treasury Internal Revenue Service - Information about Form 1128 and its separate instructions is available at www.irs.gov/form1128. Sequence No. 148

Part I General Information

Information about Form 1128 and its separate instructions is available at www.irs.gov/form1128.

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 ( ) ( )/ 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 Partnership Estate

Domestic corporation S corporation

Personal service corporation (PSC)

Cooperative (sec. 1381(a)) Controlled foreign corporation (CFC) (sec. 957)

Foreign sales corporation (FSC) or Interest-charge domestic international sales corporation (IC-DISC)

Specified foreign corporation (SFC) (sec. 898)

10/50 corporation (sec. 904(d)(2)(E)) Trust

Passive foreign investment company (PFIC) (sec. 1297)

Other foreign corporation

Tax-exempt organization Homeowners Association (sec. 528) Other (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.)
Sign Here	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title	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. ▲ Signature of filer Date ▲ Type or print name and title
Paid Preparer Use Only	Paid Preparer Use Only	Print/Type preparer’s name	Preparer’s signature	Date	Date	Check if self-employed	PTIN
Paid Preparer Use Only	Paid Preparer Use Only	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s EIN▶	Firm’s EIN▶	Firm’s EIN▶
Paid Preparer Use Only	Paid Preparer Use Only	Firm’s address▶	Firm’s address▶	Firm’s address▶	Phone no.	Phone no.	Phone no.

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)

Form 1128 (Rev. 10-2014) Page 3

Section B—Corporations (other than S corporations and controlled foreign corporations) (see instructions) 15 Enter the date of incorporation. ^▶

Form 1128 (Rev. 10-2014) Page 4 Section C—S Corporations (see instructions)

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)

Exceptions & meaning →