Free F-1122 - Florida

Authorization and Consent of Subsidiary Corporation to be Included in a Consolidated Income and Emergency Excise Tax Return

F-1122 R. 01/09
Rule 12C-1.051 Florida Administrative Code Effective 01/09

Youmustattachthisformforeachsubsidiaryincludedintheconsolidated return,forthefirstyearyoufileaFloridaconsolidatedreturn(FloridaFormF-1120). For Calendar Year or , , and ending

Other taxable year beginning

,

.

Name Street Address City
1 Dateincorporated 3 Place incorporated 4 NameofCommonParentCorporation 5 FederalEmployerIdentificationNumber (Parent)

State

ZIP
2 FederalEmployerIdentificationNumber

Thesubsidiarycorporationauthorizes: (a) The common parent corporation named above to makeaconsolidatedincometaxreturnonitsbehalf forthetaxableyearforwhichthisformisfiled. (b) Thecommonparentcorporation(or,ifitfails,the ExecutiveDirectoroftheDepartmentofRevenueora designee)tomakeaconsolidatedincometaxreturn onitsbehalfforeachfuturetaxableyearforwhicha consolidatedreturnmustbemadebytheaffiliated group.

Thesubsidiarycorporation,inconsiderationofthe privilegeofjoininginthemakingofaconsolidated returnwiththecommonparentcorporation,therefore consentstoandagreestobeboundbythetermsof section220.131,FloridaStatutes,andRule12C-1.0131, Florida Administrative Code.

Signature
Underpenaltiesofperjury,Ideclarethesubsidiarycorporationnamedabovehasauthorizedmetosignthisformon itsbehalf,andIhaveexaminedthisformandtheinformationcontainedinitis,tothebestofmyknowledgeandbelief, true,correct,andcomplete.

________________________________________________________ SignatureofOfficer/AuthorizedPerson ________________________________________________________ Title

_____________________________________ PhoneNumber _____________________________________ Date