Type of Election Is this for a newly-formed entity or a change in classification? Is this for a newly-formed entity or a change in classification? Initial classification (new entity)Changing classification (existing entity) Name of Entity What is the name of the entity filing this form? Address Provide the entity's street address: Enter the city, state, and ZIP code: EIN What is the entity's Employer Identification Number (EIN)? The entity must have an EIN to be eligible to file. Point of Contact What is the name and title of a contact person whom the IRS may contact? Provide the contact's phone number: Reasons for Filing Does one of the following special reasons for filing apply? Does one of the following special reasons for filing apply? Address changeRequesting late INITIAL classification (late election relief)Requesting late CHANGE of classification (late election relief)None of the above Has the entity previously filed an entity election with an effective date in the last 60 months? Has the entity previously filed an entity election with an effective date in the last 60 months? YesNo Was this prior filing an initial classification by a new entity that became effective on the date of formation? Was this prior filing an initial classification by a new entity that became effective on the date of formation? YesNo If no, you are likely not eligible to make the change at this time. See IRS instructions. Ownership Does the entity have more than one owner? Does the entity have more than one owner? YesNo What is the owner's name? Provide the owner's identification number: Typically a Social Security Number or other Individual Taxpayer ID Number. Parent Corporation Is the entity owned by a parent corporation? Is the entity owned by a parent corporation? YesNo What is the name of the parent corporation? Enter the parent corporation's EIN: Entity Type What is the entity want to be classified as? What is the entity want to be classified as? Domestic entity becoming an association taxed as a corporationDomestic entity becoming a partnershipDomestic entity with a single owner becoming a separate disregarded entityForeign entity becoming an association taxed as a corporationForeign entity becoming a partnershipForeign entity with a single owner becoming a separate disregarded entity Foreign Country In what country is the entity created or organized? Effective Date On what date do you want the new entity classification to be made effective? Generally the date of filing. Late Election Relief Explain the reason for the failure to file within the standard deadlines: If the classification date is to be more than 75 days before or more than 12 months after the date of filing, the entity will have to provide reasonable cause in this section. See the IRS instructions for more information. After completing this form, an authorized representative and all affected parties must sign the Late Election Relief section. After completing this form, an authorized representative and all affected parties must sign the Late Election Relief section. I Understand Signature Would you like to sign the form now? Would you like to sign the form now? YesNo Please draw your signature: Clear Please draw your signature. What is your title? Date of signature: Next Save Save and finish later
