Signature This form is only required to be attached to the Florida

F-1122
R. 01/13
Authorization and Consent of Subsidiary Corporation to be
Included in a Consolidated Income Tax Return
Rule 12C-1.051
Florida Administrative Code
Effective 01/13
This form is only required to be attached to the Florida Form F-1120 for a subsidiary’s
initial authorization to be included in the Florida consolidated income tax return.
For Calendar Year
or
Other taxable year beginning
,
, and ending
,
.
Name
Street Address
City
State
1 Date incorporated
ZIP
2 Federal Employer Identification Number
3 Place incorporated
4 Name of Common Parent Corporation
5 Federal Employer Identification Number
(Parent)
The subsidiary corporation authorizes:
(a) The common parent corporation named above to
make a consolidated income tax return on its behalf
for the taxable year for which this form is filed.
(b) The common parent corporation (or, if it fails, the
Executive Director of the Department of Revenue or a
designee) to make a consolidated income tax return
on its behalf for each future taxable year for which a
consolidated return must be made by the affiliated
group.
The subsidiary corporation, in consideration of the
privilege of joining in the making of a consolidated
return with the common parent corporation, therefore
consents to and agrees to be bound by the terms of
section 220.131, Florida Statutes, and Rule 12C-1.0131,
Florida Administrative Code.
Signature
Under penalties of perjury, I declare the subsidiary corporation named above has authorized me to sign this form on
its behalf, and I have examined this form and the information contained in it is, to the best of my knowledge and belief,
true, correct, and complete.
________________________________________________________
Signature of Officer / Authorized Person
______________________________________
Phone Number
________________________________________________________
Title
______________________________________
Date