F-1122
                     Authorization and Consent of Subsidiary Corporation to be                          R. 01/13
                                                                                                                      TC
                            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                        ZIP

1  Date incorporated                                                         2  Federal Employer Identification Number

3  Place incorporated

4  Name of Common Parent Corporation                                         5  Federal Employer Identification Number
                                                                                            (Parent)

The subsidiary corporation authorizes:                         The subsidiary corporation, in consideration of the 
                                                               privilege of joining in the making of a consolidated 
 (a)  The common parent corporation named above to 
                                                               return with the common parent corporation, therefore 
      make a consolidated income tax return on its behalf 
                                                               consents to and agrees to be bound by the terms of 
      for the taxable year for which this form is filed. 
                                                               section 220.131, Florida Statutes, and Rule 12C-1.0131, 
 (b)  The common parent corporation (or, if it fails, the      Florida Administrative Code. 
      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.

                                                         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

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Title                                                           Date