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EFTA01222582

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F.. 1045 Department of the Treasury Internal Revenue Service Application for Tentative Refund dividuals, No.1545- a Iii. For In states, or trus . P Mail In separate envelope .(Don't attach to tax return.) le Go to www.lts.gov/Forrn1045 for the latest Information. OMB 2018 ti .c a ° Name(s) shown on return Social security or employer Identification number Number. street. and apt. or site no. If a P.O. box. see instructions. Spouse's social security number (SSN) City. town or post office, state, end ZIP code. If a foreign address. also complete spaces below (see instructions). Daytime phone number Foreign country name Foreign province/county Foreign postal code 1 ThIs application is filed to carry back: a Net operating loss (NOL) (Sch. A. line 25) $ b Unused general business credit $ c Net section 1256 contracts loss $ 2a For the calendar year 2018, or other tax year beginning .2018, and ending . 20 b Date tax return was filed 3 If this application is for an unused credit created by another carryback, enter year of first carryback ► 4 If you filed a joint return (or separate return) for some, but not all, of the tax years involved in figuring the carryback. list the years and specify whether joint (J) or separate (S) return for each ► 5 If SSN for canyback year is different from above, enter a SSN ► and b Year(s) OP. 6 If you changed your accounting period, give date permission to change was granted ► 7 Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied? 0 Yes 0 No 8 is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be disclosed on Form 8886, Reportable Transaction Disclosure Statement? 0 Yes 0 No 9 If you are carrying back an NOL or net section 1256 contracts loss, did this cause the release of foreign tax 0 Yes El No credits or the release of other credits due to the release of the foreign tax credit

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