California Request for Consent for a Water's-Edge Re-Election (Fill-in)

Request for Consent for a Water's-Edge Re-Election (Fill-in)
2023 Form 1115 Request for Consent for a Water’s-Edge Re-Election
TAXABLE YEAR

20□□

Request for Consent for a Water’s-Edge
Re-Election

CALIFORNIA FORM

1115

Fill out the form completely. Do not change the method of filing until the Franchise Tax Board has approved this request.
Corporation name

Key California corporation number

Address (suite, room, or PMB no.)
City

Part I

State

ZIP code

Effective Dates

Enter the taxable year ending date of the taxpayer’s last filed water’s-edge tax return: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

•

Enter the beginning date of the water’s-edge re-election: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

•

/	/

(mm/dd/yyyy)

/	/

(mm/dd/yyyy)

Part II

Basis to Request a Water’s-Edge Re-Election. See instructions.

Explain the basis for the request to re-elect water’s-edge. Attach additional sheets if necessary.

Part III List of Taxpayers Requesting Water’s-Edge Re-Election. Attach additional sheets if necessary.
Taxpayer’s name

California corporation number

FEIN

Signature
I attest to the belief that the water’s-edge re-election is permitted by law and to the accuracy of factual statements.
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge,
it is true, correct, and complete.

___________________________________________________ 	 _______________________________________	 __________________
Signature of officer

___________________________________________________
Print or type name of person to contact

Title

Date

(
)
______________________________________
Telephone

THIS FORM MUST BE FILED SEPARATELY FROM THE TAX RETURN

7181233

FTB 1115

2023