Form Affiliations Schedule For tax year ending OMB No. 1545-0123 Rev. October 2016 File with each consolidated income tax return. Department of the Treasury Information about Form 851 and its instructions is at www.irs.gov/form851. Purpose of Form Use Form 851 to 1. Identify the common parent corporation and each member of the affiliated group 2. Section references are to the Internal Revenue Code unless otherwise noted. Future Developments For the latest information about developments related to Form 851 and its instructions such as legislation enacted after they were published go to www.irs.gov/form851. Determine that each subsidiary Who Must File The parent corporation must file Form 851 for itself and for corporations in the affiliated group. File Form 851 by attaching it to the consolidated tax return for the group. includible corporations connected through stock ownership with a common parent common parent must be an includible must be met. Yes No For Paperwork Reduction Act Notice see instructions. Cat. No. 16880G Form 851 Rev. 10-2016 Page Changes in Stock Holdings During the Tax Year Name of corporation Shareholder of Corporation No. a Changes Date transaction Number of acquired disposed of b Shares held after changes described in column a voting power d c If any transaction listed above caused a transfer of a share of subsidiary stock defined to include dispositions and deconsolidations did the share s basis exceed its value at the time of the transfer See instructions. Internal Revenue Service Name of common parent corporation Employer identification number 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* Overpayment Credits Estimated Tax Payments and Tax Deposits see instructions Name and address of corporation Portion of and estimated tax payments Employer identification number deposited with Form 7004 Common parent corporation Subsidiary corporations Totals Must equal amounts shown on the consolidated tax return*. Principal Business Activity Voting Stock Information Etc* see instructions PBA Code Stock holdings at beginning of year Did the subsidiary make any nondividend Number Percentage Owned by Percentage distributions of of voting corporation of value shares power no. Did any share of subsidiary stock become worthless within the meaning of section 165 taking into account the provisions of Regulations section 1. 1502-80 c during the taxable year See instructions. e If the equitable owners of any capital stock shown above were other than the holders of record provide details of the changes. f If additional stock was issued or if any stock was retired during the year list the dates and amounts of these transactions. During the tax year did the corporation have more than one class of stock outstanding. If Yes enter the name of the corporation and list and describe each class of stock. Class of stock disaffiliation. Additional Stock Information see instructions Explanation members of the affiliated group could acquire any stock or acquire any voting power without acquiring stock in the corporation other than a de minimis amount from the corporation or another member of the affiliated group.
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