Tennessee Consolidated Net Worth Application for Registration

Consolidated Net Worth Application for Registration
Consolidated Net Worth Election Registration Application
TENNESSEE DEPARTMENT OF REVENUE

RV-F1308301 (08/20)

Consolidated Net Worth
Election Registration Application

This application must be completed by affiliated groups and financial institution affiliated groups electing to compute
the net worth base for franchise tax purposes on a consolidated basis.
Check all boxes that apply:
New election
Amended election to add or remove group members
Revoke election
Application is for a financial institution affiliated group
Effective Date of the Election:

Start

End (if revoking election)
Account Number

FEIN

Secretary of State Control Number
Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number

Email

Describe the group’s predominate business activity, stating the major products and/or services sold (affiliated group):

The statements made on this application are true to the best of my knowledge and
belief. This application must be signed by the individual owner, a partner, or or an
officer of the corporation.

Signature of owner, partner, officer (do not use stamp)	

Date

Mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Building
500 Deaderick Street
Nashville, Tennessee 37242

Part 1 - Affiliated group members or financial institution affiliated group members subject to Tennessee
franchise and excise tax
Check if amended:

New member

Remove member

Effective date

Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number
FEIN

Email
SOS Control Number

Account Number

Check if amended:

New member
Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent

Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number
FEIN

Check if amended:

Email
Account Number

New member

SOS Control Number

Remove member

Effective date

Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number
FEIN

Email
SOS Control Number

Account Number

Check if amended:
New member
Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number
FEIN

Email
Account Number

SOS Control Number

Part 2 - Affiliated group members or financial institution affiliated group members not subject to Tennessee
franchise and excise tax
Check if amended:
New member
Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Telephone Number

Check if amended:

Email

New member

Remove member

Effective date

Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

City

State

ZIP Code

Street

City

State

ZIP Code

Email

Check if amended:
New member
Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name
Physical Location (no P.O. Box)
Mailing Address

City

State

ZIP Code

Street

City

State

ZIP Code

Email

Check if amended:
New member
Remove member Effective date
Check if entity is a single member LLC filing as a division of the parent
Legal Name

Telephone Number

FEIN

Street

Telephone Number

Physical Location (no P.O. Box)

FEIN

Street

Telephone Number

Mailing Address

FEIN

FEIN

Street

City

State

ZIP Code

Street

City

State

ZIP Code

Email

Instructions: Consolidated Net Worth Election Registration Application
Members of an affiliated group or a financial institution affiliated group may make a group election to compute
their net worth base for franchise tax purposes on a consolidated basis. An affiliated group is comprised of the
following: 1) a taxpayer that, standing alone, is subject to Tennessee franchise tax; 2) all other domestic persons in
which the taxpayer, directly or indirectly, has more than a 50% ownership interest; 3) all other domestic persons
that, directly or indirectly, have more than a 50% ownership interest in a taxpayer; and 4) all other domestic persons
in which a person described in (3) above, directly or indirectly, has more than a 50% ownership interest, regardless
of whether such persons do business in Tennessee. A domestic person means any person with more than 20% of
the average of its property, payroll, and receipts factors in the United States (Tenn. Code Ann. §§ 67-4-2004 and 674-2103).
This election must be made on or before the due date of the tax return for the period for which the election is to
take effect. This election form is not for filing a combined return. Combined returns can only be filed by financial
institutions that are members of a unitary group.
This election is a group election. All affiliates, as defined in Tenn. Code Ann. § 67-4-2004(1), are bound by the
election and must compute their net worth franchise tax base, reflected on their separate-entity franchise and
excise tax returns, on a consolidated basis. The election remains in effect for a minimum of five tax years, and it
continues to remain in effect until revoked. An amended registration form should be filed annually if a member of
the group enters or leaves the group at any time during the tax year.
This election is not allowed unless each member of the group closes its taxable year on the same date. However,
the election is permitted when a member exits the group during the taxable year because of a change in ownership,
merger, or liquidation of the member. When this happens, the member exiting the group is excluded from the
group and computes its net worth on an unconsolidated basis.
This application must be signed and dated at the bottom of the first page by the owner, partner, or officer, and it
must be mailed to the address indicated. Do not attach to your franchise and excise tax return.