This is an example of a completed Form 1120-S (Page 1 only). The IRS Received Date is not present and the return is signed by a Revenue Officer Top left corner of Form 1120-S reads: DRAFTTC599 - Transaction Code 599 is written in the upper left margin of the Form 1120-S.Box A shows 7-5-87 for the effective date of the S electionBox B shows 238100 for the Business Activity CodeBox D shows 00-4560114 for the Employer Identification Number (EIN)Box E shows 7-5-87 for the date incorporated.Willow Cement Co. is shown on the name line and WILL is underlined as the name control3600 Fir Rd. is shown for the street address lineHartford, CT 06101 is shown for the city, state, and ZIP code lineBox F shows $27,460 for Total AssetsBox I shows 2 for the Number of Shareholders during any part of the tax yearLine 1a, Gross receipts or sales, shows 44,620Line 1c, Balance, shows 44,620Line 2, Cost of goods sold, shows 31,229Line 6, Total income (loss) shows 13,391The Received Date 080221 is edited in red in the center of the form.Sign Here box: Signature of officer: B. Birch, Revenue OfficerSign Here box: Date: 8-2-21