Form 966 2010

If the resolution or plan is amended or supplemented after Form 966 is filed file another Form 966 within 30 days after the amendment or supplement is adopted. The additional form will be sufficient if the date the earlier form was filed is entered on line 11 and a certified copy of the amendment or supplement is attached. Include all information required by Form 966 that was not given in the earlier form. Who Must File A corporation or a farmer s cooperative must file Form 966 if it adopts a resolution or plan to dissolve the corporation or liquidate any of its stock. For purposes of determining gain or loss the Cat. No. 17053B Rev. 12-2010 Form 966 Rev. 12-2010 distributed assets are valued at fair market value. Foreign corporations that are not required to file Form 1120-F U.S. Income Tax Return of a Foreign Corporation or any other U.S. tax return are generally not required to file Form 966. Signature of officer Title Date Instructions When To File Section references are to the Internal Revenue Code unless otherwise noted. File Form 966 within 30 days after the resolution or plan is adopted to dissolve the corporation or liquidate any of its stock. Exempt organizations and qualified subchapter S subsidiaries should not file Form 966. Exempt organizations should see the instructions for Form 990 Return of Organization Exempt From Income Tax or Form 990-PF Return of Private Foundation or Section 4947 a 1 Nonexempt Charitable Trust Treated as a Private Foundation. Subchapter S subsidiaries should see Form 8869 Qualified Subchapter S Subsidiary Election. CAUTION Do not file Form 966 for a deemed liquidation such as a section 338 election or an election to be treated as a disregarded entity under Regulations section 301. Of common parent consolidated return was filed Yes 7c Name of common parent No Common Preferred Total number of shares outstanding at time of adoption of plan of liquidation Date s of any amendments to plan of dissolution Section of the Code under which the corporation is to be dissolved or liquidated If this form concerns an amendment or supplement to a resolution or plan enter the date the previous Form 966 was filed Attach a certified copy of the resolution or plan and all amendments or supplements not previously filed. Under penalties of perjury I declare that I have examined this form including accompanying schedules and statements and to the best of my knowledge and belief it is true correct and complete. Form Corporate Dissolution or Liquidation Rev. December 2010 Please type or print OMB No. 1545-0041 Required under section 6043 a of the Internal Revenue Code Department of the Treasury Internal Revenue Service Name of corporation Employer identification number Number street and room or suite no. Exceptions to this rule apply to a liquidation of a subsidiary and to a distribution that is made according to a plan of reorganization. Foreign Corporations 966 if required under section 6043 a. If a P. O. box number see instructions. Check type of return Date incorporated Place incorporated Service Center where corporation filed its immediately preceding tax return Type of liquidation Complete Last month day and year of immediately preceding tax year 1120-L 1120-IC-DISC City or town state and ZIP code 1120S Other Date resolution or plan of complete or partial liquidation was adopted Partial final tax year 7b Was corporation s final tax return filed as part of a consolidated income tax return If Yes complete 7c 7d and 7e.