U.S. TREAS Form treas-irs-851-2003
Form
851
Affiliations Schedule
(Rev. December 2003)
䊳
Department of the Treasury
Internal Revenue Service
Tax year ending
OMB No. 1545-0025
File with each consolidated income tax return.
,
Employer identification number
Name of common parent corporation
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
Part I
Corp.
No.
1
Overpayment Credits, Estimated Tax Payments, and Tax Deposits (See instructions.)
Name and address of corporation
Portion of
overpayment credits
and estimated
tax payments
Employer
identification
number
Portion of tax
deposited with
Form 7004
Common parent corporation
Subsidiary corporations:
2
3
4
5
6
7
8
9
10
䊳
Totals (Must equal amounts shown on the consolidated tax return.)
Part II
Corp.
No.
Principal Business Activity, Voting Stock Information, Etc. (See instructions.)
Principal business activity (PBA)
PBA
Code
No.
Did the subsidiary
make any nondividend
distributions?
Yes
No
Stock holdings at beginning of year
Number
of
shares
Percent of Percent of Owned by
voting
corporation
value
power
no.
Common parent corporation:
1
Subsidiary corporations:
2
%
%
3
%
%
4
%
%
5
%
%
6
%
%
7
%
%
8
%
%
9
%
%
10
For Paperwork Reduction Act Notice, see instructions.
%
Cat. No. 16880G
Form
%
851
(Rev. 12-2003)