Tax Election Application

TAX ELECTION APPLICATION

Taxpayer Name:

Entity Type

Check the box that best describes the taxpayer for whom this election is submitted:

Individual / Sole Proprietor

C Corporation

S Corporation

Partnership

Trust / Estate

LLC

Other — specify below

Taxpayer Identification Number

Provide either the Social Security Number (SSN) or Employer Identification Number (EIN). Do not provide both; leave the unused field blank.

Election Requested

Select the specific tax election being requested. Complete all supplemental information requested for the election chosen.

S Corporation Election (Section 1362) — attach shareholder consent and allocation schedule as required.

Change in Accounting Method or Period — provide description and proposed method.

Section 754 Election — attach computations and supporting schedules.

Section 179 Election — list assets and cost basis in the statement of facts.

Choice of Fiscal Year / Short-Year Return — explain fiscal year and reason.

Other Election — specify below.

Effective date for the election:    Tax year to which this election applies:

Statement of Facts and Supporting Information

Provide a concise factual narrative setting forth the circumstances that qualify the taxpayer for the election and any computations, schedules, or authority relied upon. If additional space is required, attach schedules and list attachments below.

Certification and Penalties

By signing below, the taxpayer certifies, under penalty of perjury, the following:

1. The taxpayer is the individual or an authorized representative of the entity identified on this form and is authorized to make the election requested.
2. The information contained in this application, including attached schedules and statements, is true, correct, and complete to the best of the taxpayer’s knowledge and belief.
3. The taxpayer understands that the election, if accepted, will be binding for the period specified by applicable law and may affect the taxpayer’s reporting obligations for the election period and subsequent periods.
4. The taxpayer acknowledges that false statements or willful omission of material information may subject the taxpayer to penalties under applicable law, including criminal penalties where appropriate.
5. The taxpayer agrees to furnish additional information or documentation if required by tax authorities to determine the appropriateness or timing of the election.

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