1122 Authorization and Consent of Subsidiary Corporation To B

Form

1122

Authorization and Consent of Subsidiary Corporation
To Be Included in a Consolidated Income Tax Return

(Rev. December 2003)
Department of the Treasury
Internal Revenue Service

For the calendar year 20

䊳

Attach to the consolidated income tax return.

, or other tax year beginning

, 20

and ending

Name

, 20
Employer identification number

Number, street, and room or suite no.

City or town, state, and ZIP code
Name of parent corporation

Employer identification number

The subsidiary corporation named above authorizes its parent
corporation to include it in a consolidated return for the tax year
indicated and for each subsequent year the group must file a
consolidated return under the applicable regulations. If the
parent corporation does not file a consolidated return on

Sign
Here

behalf of the subsidiary, the subsidiary authorizes the
Commissioner of the Internal Revenue Service or an IRS
official to do so.
The subsidiary consents to be bound by the provisions of
the consolidated return regulations.

Under penalties of perjury, I declare that the subsidiary named above has authorized me to sign this form on its behalf, that I have examined this
form and the information contained herein, and to the best of my knowledge and belief, it is true, correct, and complete.

䊳

Signature of subsidiary officer

Date

Instructions for the subsidiary corporation. Complete and
submit an original, signed Form 1122 to the common parent
corporation of the consolidated group for the first tax year the
subsidiary consents to be included in the group’s consolidated
income tax return.
Instructions for the parent corporation filing the
consolidated return. The common parent corporation of a
consolidated group must attach a separate Form 1122 to the
group’s consolidated income tax return for each subsidiary

䊳

Title

corporation for the first tax year each subsidiary consents to
be included in the consolidated return. Attach to the
consolidated return either the signed Form 1122 or an
unsigned version containing the same information stated on
the signed form. If the parent corporation submits an
unsigned Form 1122, it must retain the original, signed form
in its records.

Cat. No. 17228S

Form

1122

(Rev. 12-2003)