Form 1139 Corporation Application for Tentative Refund

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1139, PAGE 1 of 2 (Page 2 is Blank.)
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: FACE ONLY
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216mm (8-1⁄2 ") x 279mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

1139

Action

Date

O.K. to print
Revised proofs
requested

Corporation Application for Tentative Refund
䊳

(Rev. August 2006)
Department of the Treasury
Internal Revenue Service

䊳

OMB No. 1545-0582

See separate instructions.

Do not file with the corporation’s income tax return—file separately.

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

Signature

Reason(s) for filing.
See instructions—
attach computation

)

a Net operating loss (NOL)

䊳

$

c Unused general
business credit 䊳 $

b Net capital loss

䊳

$

d Other

$

2

Return for year of loss, unused credit, or
overpayment under section 1341(b)(1) 䊳

3

If this application is for an unused credit created by another carryback, enter ending date for the tax year of the first carryback 䊳

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
6a

a Tax year ended

䊳

b Date tax return filed c Service center where filed

If “Yes,” enter the tax year ending date and the name of the common parent and its EIN, if different from above (see instructions) 䊳
If Form 1138 has been filed, was an extension of time granted for filing the return for the tax year of the NOL?

b

If “Yes,” enter the date to which extension was granted 䊳

d

Unpaid tax for which Form 1138 is in effect

䊳$

If the corporation changed its accounting period, enter the date permission to change was granted

䊳

7
8
9
10

䊳
If this is an application for a dissolved corporation, enter date of dissolution
Has the corporation filed a petition in Tax Court for the year or years to which the carryback is to be applied?
Does this application include a loss or credit from a tax shelter required to be registered? If “Yes,” attach Form(s) 8271

Computation of Decrease in Tax
See instructions.
Note: If only filing for an unused general business
credit (line 1c), skip lines 11 through 15.
11

preceding
tax year ended 䊳
(a)Before
carryback

No

Yes
Yes

No
No

preceding
tax year ended 䊳

(b)After
carryback

(c)Before
carryback

preceding
tax year ended 䊳

(d)After
carryback

(e)Before
carryback

(f)After
carryback

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
Decrease in tax. Subtract line 26 from line 25
Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)

27
28

Yes

c Enter the date Form 1138 was filed 䊳

Sign
Here
Keep a copy of
this application
for your records.

Preparer Other
Than Taxpayer

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.

䊳

Signature of officer

Name

䊳

Date

Title

Date

䊳

Address

䊳

䊳

For Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 11170F

Form

1139

(Rev. 8-2006)