Form 4876-A
(Rev. April 1993)
Election To Be Treated as an OMB No. 1545-0190
Department of the Treasury Interest Charge DISC Expires 4-30-96
Internal Revenue Service
The corporation named below elects to be treated as an interest charge domestic international sales corporation
Part I (IC-DISC) for income tax purposes. All of the corporation’s shareholders must consent to this election.
Name of corporation A Employer identification number
Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address) B Business classification code (see
instructions)
City or town, state, and ZIP code
D Name of person who may be called for
information: (optional)
C Tax year of IC-DISC: Must use tax year of principal shareholder (see instructions). Enter
ending month and day
E Election is to take effect for the tax year beginning F Date corporation began doing business Telephone number:
(month, day, year) ( )
H Number of shares of stock held on—
G Name and address (including ZIP code) of each shareholder (or expected (Complete both columns for each shareholder.) I Identifying number
shareholder) at the beginning of the tax year the election takes effect and when First day of year Date consent (see instructions)
the election is filed. of election is made
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Total. Enter total shares for all shareholders (include shares of shareholders listed on
any attachments)
Under penalties of perjury, I declare that the corporation named above has authorized me to make this election for the corporation to be treated as an IC-DISC and
that the statements made are to the best of my knowledge and belief true, correct, and complete.
Signature and Title of Officer Date , 19
Shareholders’ Consent Statement. This may be used instead of attachments. For this election to be valid, each
Part II shareholder must sign below or attach a separate consent to this form (see instructions).
We, the undersigned shareholders, consent to the election of the corporation named above to be treated as an IC-DISC. Our consent is irrevocable and is binding
upon all transferees of our shares in this corporation.
Signature of shareholder and date. (If consent involves transferred shares, attach a schedule showing the name and address of the holder of the shares at the
beginning of the tax year and the number of shares for which the consent is made.)
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For Paperwork Reduction Act Notice, see instructions on back. Cat. No. 62075X Form 4876-A (Rev. 4-93)
Form 4876-A (Rev. 4-93) Page 2
General Instructions Ineligible Organizations.—S corporations, each person must sign. The legal guardian
Section references are to the Internal certain financial institutions and other should sign for a minor; if none has been
Revenue Code unless otherwise noted. corporations listed in section 992(d) are not appointed, the natural guardian should sign.
eligible for IC-DISC treatment. The executor or administrator should sign
Paperwork Reduction Act Notice
We ask for the information on this form to When To File for an estate, and the trustee should sign for
A corporation electing to be treated as an a trust. If the estate or trust has more than
carry out the Internal Revenue laws of the
IC-DISC for its first tax year should complete one executor, administrator, or trustee, any of
United States. You are required to give us the
and file Form 4876-A within 90 days after the them who is authorized to file the returns may
information. We need it to ensure that you are
beginning of such tax year. A corporation sign the consent. For a corporation or
complying with these laws and to allow us to
electing to be treated as an IC-DISC for any partnership, an officer or partner who is
figure and collect the right amount of tax.
tax year that is not its first tax year must authorized to sign the other returns may sign
The time needed to complete and file this the consent for the IC-DISC election.
form will vary depending on individual make the election during the 90-day period
circumstances. The estimated average time immediately preceding the first day of that tax A foreign person’s consent may be signed
is: year. by any individual who would be authorized to
Recordkeeping 4 hr., 4 min. For the election to be valid, all the sign if the person were a U.S. person.
corporation’s shareholders, as of the first day Extension.—Normally, the consents must be
Learning about the law
of the tax year the election is to take effect, attached to Form 4876-A. If you establish
or the form 1 hr., 5 min.
must consent to it. reasonable cause for not filing a consent on
Preparing and sending
the form to the IRS 1 hr., 13 min. Where To File time, you may file the consent within an
If you have comments concerning the File Form 4876-A with the IRS Service Center extended period granted by an Internal
accuracy of these time estimates or where the corporation will file its annual Revenue Service Center. File the consents
suggestions for making this form more return, Form 1120-IC-DISC, Interest Charge with the same service center where you filed
simple, we would be happy to hear from you. Domestic International Sales Corporation Form 4876-A.
You can write to both the Internal Revenue Return. If shares are transferred before a consent
Service, Attention: IRS Reports Clearance is filed, the transferee shareholder may
Officer, T:FP; Washington, DC 20224, and the Specific Instructions consent to the IC-DISC election as long as
Office of Management and Budget, the transfer occurs and the consent is filed
Paperwork Reduction Project (1545-0190), Part I within the first 90 days of the tax year. The
Washington, DC 20503. DO NOT send this Address.—Include the suite, room, or other service center may grant an extension
form to either of these addresses. Instead, unit number after the street address. If the beyond that date. If the transfer takes place
see Where To File, below. Post Office does not deliver mail to the street more than 90 days after the tax year began,
Purpose address, show the P.O. box number instead an extension can be granted only if the
of the street address. transferor was eligible for one.
A corporation files Form 4876-A to elect to be
treated as an interest charge domestic Item B—Business classification.—See the Separate statement.—Any shareholder who
international sales corporation (IC-DISC). instructions to Form 1120 or Form does not sign the consent in Part II of Form
Once the election is made, it remains in 1120-IC-DISC for the list of Codes for 4876-A must sign a separate consent
effect until terminated or revoked. It applies Principal Business Activity and Principal statement for the election to be valid. The
to each person who owns stock in the Product or Service. Enter the corporation’s statement must say: “I, (shareholder’s name),
corporation while the election is in effect. business code number, principal business a shareholder of (corporation’s name) consent
activity, and principal product or service. to the election of (corporation’s name) to be
What Is an IC-DISC treated as an IC-DISC. The consent so made
An IC-DISC is a U.S. corporation that meets Item C—Tax year change.—If a corporation
electing to be an IC-DISC has to change its by me is irrevocable and is binding on all
certain conditions regarding its organization transferees of my shares in (corporation’s
and international sales and that elects to be tax year to conform to the tax year of its
principal shareholder to meet the name).”
treated as an IC-DISC. The corporation must
be organized under the laws of a state or the requirements of section 441(h), the In addition, the statement must show (1)
District of Columbia and meet the following corporation does not need IRS consent to the names, addresses, and identification
tests: make the change. A tax year change by a numbers of both the corporation and the
principal shareholder or a subsequent change shareholder; (2) the number of shares the
● At least 95% of its gross receipts during by the corporation to meet the tax year shareholder owned (or expects to own) at the
the tax year are qualified export receipts. requirements of section 441(h) may require beginning of the tax year the election takes
● At the end of the tax year, the adjusted IRS consent. See section 442 and the effect; and (3) the number of shares the
basis of its qualified export assets is at least regulations under sections 441, 442, and 921 shareholder owns when making the consent.
95% of the sum of the adjusted basis of all for more information. For transferred stock, also show the name
its assets. Column I—Identifying number.—The and address of the person who held the
● It has one class of stock, and its identifying number for an individual is the shares at the beginning of the tax year and
outstanding stock has a par value of at least social security number. For all others it is the the number of shares to which this consent
$2,500 on each day of the tax year (or, for a employer identification number. applies.
new corporation, on the last day for electing Signature.—Form 4876-A must be signed by Supplemental Form 4876-A.—If, between
IC-DISC treatment and on each succeeding the president, vice president, treasurer, the date the election is filed and the date it
day). assistant treasurer, chief accounting officer, takes effect, the corporation issues more
● It keeps separate books and records. or other officer (such as tax officer) shares of stock or the share ownership
authorized to sign for the corporation. changes, it must file a supplemental Form
● Its tax year must conform to the tax year of
the principal shareholder who has the highest 4876-A, with “SUPPLEMENTAL” written
Part II across the top of the form. The form must be
percentage of voting power. If two or more
shareholders have the highest percentage of Shareholders’ Consent Statement.—An filed within the first 90 days of the tax year
voting power, the IC-DISC’s tax year may be election for IC-DISC treatment will be valid the election takes effect.
the same as that of any of those only if all shareholders sign either the consent On the supplemental form, include all the
shareholders. (See section 441(h) for statement in Part II or a separate statement information from the earlier form except for
additional information.) as described below. Several shareholders the list of owners contained in Parts I and II.
may combine their consents in one Report only the owners of the new or
● Its election to be treated as an IC-DISC is statement.
in effect. additional shares in Part I, and in Part II
If a husband and wife jointly own the stock obtain their consents only. Each new
See section 992 and the related regulations or the income from it, both must sign the shareholder or holder of additional shares
for details. Also see section 993 and its consent. If tenants in common, joint tenants, must consent to the IC-DISC election for the
related regulations for definitions of qualified or tenants by the entirety own the stock, Supplemental Form 4876-A to be valid.
export receipts and qualified export assets.