Free F-851 - Florida

Corporate Income/Franchise and Emergency Excise Tax

Attach this schedule to Form F-1120

F-851 R. 01/09
Rule 12C-1.051 Florida Administrative Code Effective 01/09

Affiliations Schedule
For Calendar Year or , , and ending

Other taxable year beginning

,

.

Who must file Form F-851? This form must be used by taxpayers filing a Florida consolidated income tax return and is used to report the members of the consolidated group. It must be filed by the parent corporation of the consolidated group. You may substitute IRS Form 851 if the federal and Florida consolidated groups are identical. Report changes to the consolidated group in Part II, on the reverse side of this form. PART I
Florida Common Parent Corporation Address (Number, Street, City, State, and ZIP) Federal Employer Identification Number (FEIN)

-

No. 1 2 3 4 5 6 7 8 9 10

Name and Address of Corporation
Common parent corporation: Subsidiary corporation:

% of Ownership -

FEIN

Statement of Affiliation -- Do the above corporations comprise an affiliated group of corporations as described in section (s.) 1504(a) of the Internal Revenue Code? Remarks:

Yes

No

Under penalties of perjury, I declare that I have examined the above information and statements and they are true, correct, and complete to the best of my knowledge and belief, for the taxable year as stated above.

_______________________________________
Signature of Officer

_______________________________________________
Date

_______________________________________
Title

_______________________________________________
Telephone Number

Schedule of Consolidated Changes
PART II

F-851 R. 01/09 Page 2

Use the schedule below to record any changes that occurred during the tax year that caused the corporations included in the consolidated return to change. List all affected corporations and indicate whether they are deletions or additions by checking the correct box. Deletions are any subsidiary members that are no longer included in the consolidated return but were included in last year's return. 3One Does corporation have Florida:

Deletion

Addition

FEIN -

Name of Corporation

Property? Payroll?
(Yes/No) (Yes/No)

Sales?
(Yes/No)

NAICS Code

For Information and Forms
Information and forms are available on our Internet site at To receive forms by mail: · Order multiple copies of forms from our Internet site at www.myflorida.com/dor/forms or · Mail form requests to: Distribution Center Florida Department of Revenue 168A Blountstown Hwy Tallahassee FL 32304-3761 Department of Revenue service centers host educational seminars about Florida's taxes. To get a schedule of upcoming seminars or to register for one, · Visit us online at www.myflorida.com/dor or · Call the service center nearest you.

www.myflorida.com/dor
To speak with a Department of Revenue representative, call Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m., ET, at 800-352-3671. Persons with hearing or speech impairments may call our TDD at 800-367-8331 or 850-922-1115. For a written reply to tax questions, write: Taxpayer Services Florida Department of Revenue 5050 W Tennessee St Bldg L Tallahassee FL 32399-0112