EFTA00619958.pdf

rove 8621 Information Return by a Shareholder of a Passive Foreign oonio. ISIS WO/ Migro Investment Company or Qualified Electing Fund ree 2Jr;} I el the Tratowl, Wail Aram Sonia lb Information about Form 8621 and its separate instruction is at is,,„,v gnigye,„nag91 I SEISM. he. 69 Name 01 starehober identifying amber (see instrucnons) THE HAZE TRUST 2 -- Number, erect, and room or suite to. (If a. tax, see InCructiors.) SKIrohnle in year eihnder year 012. ore. m yr bernie0 6100 RED HOOK QUARTER, B3 ad wino City or town, stabs, and ZIP bodeOr Counby ST THOMAS, VI 00802 IJ Check type ol shareholder limpthereturrc Irdividhal LJ Corporation IJ Partnersh LJ S Corporation LJ None:ant& Trust LI Estate Name of passive foreign Investmew. company (FFIC)er qualified totting fund (QEF) Employer Idendlicadon member (if airy) HIGHERIDOE CAPITAL CORPORATION r Em r n mbar strove c or tom' and cou Reference ID number (set instructiors) Tax year of PFIC or OFF: calends year 2012 woo ter year begirning and ending I. Part I , ' Summary of Annual Information Part I is reserved for future use (see instructions). Provide the frebning inforrnehon with respect to an steles d the PFIC held by the shareheeter. 1 Description of each class of shares held by the snarePolder. CD Check if shares jointlyowned with spouse. 2 Dale shares acquired duringMe taxable 'tar, f applicable: 3 Number of shares held al the end at the taxable year: 4 Vat of stares held at the ead of the fable year (deck the appropriate box, ilapebtabbK (a) ED 30-53,000 (I) IL) $50,00M00,000 (a) I= $100.001.160,000 (d) O SI50,601,200,000 (e) II more than5200.000,m yak& 6 Type of PK and amount or any excess distribution or gain treated as an excess distibuton under section 1291, irclusioe under secoon 1293, or inclusion or deducton under section 1296: (a) CI Section 1291 $ (b) C Section 1293 (gratified Recline Fts) (e) al Section 1296 (Mark to Market) S Partil I Elections (See instructions.) A LIUElection Te Treat me PFIC as a OEF. I, a shareholder of a PFIC, ektel to treat tie PFIC as e0EF. Complete kws 6e through 7c of Part Ill. B CD Election To Extend Time For Payment of Tax. I, a stareholeer of a tIEF, elect to extend the time for payment of lax on the undistiOund earnings and Drafts of the Off until this etralon 6 terrniated. Complete ones 8a through 9c of Pan to calculate the tax that may be deferred. Nets: if any portion of tine 6a or one 7a of Part IIIis includible undo section 951, you mayn04 make this election. Also, see sections 7294(c) and 1294(0 and the rated regubtions tar events tat terminate this election. C C Recibir To Mal•to-learket PFIC Stock. I, a shareholder of a PFIC. elect to mark-to-market the PFIC stook that is marketable witin [bemoaning of section 1298(e). Complete Pat IV. D O Deemed Sale Election. I, a shareholder on the rest day of a PFIC's First tax year as a GEE, reel to recognize gen on the darnedsale0 my Interest in Me PFIC. Enter gain orlon on Me 751ofPart V. E 0 eetned Mrldend Elution. a shareholder on the leg day of a PFtC's first tax year as a Cif that b a controlled ImIgn corporation ( C), elect to kcal an amount equal to my site olne pcst.1986 earnings and profits of the t7-C as an excess daribution. Enter this amount on fire 15e of Part V. If the excess dbtriburion is greater than zero, also complete line 16 of Part V. F O Election To Recognize Bain en Deemed Sale of PFIC. I, a shareholder of PFIC or a PFIC to which section 1297(d) agues, elect to west as an excess distribution the gain recognized on the deemed sale 0 my interest in the PRO on the last dry of Its last tax yer as a PFIC under whoa 1297(a). Enter gain on one 15f of Pert V. G rn Deemed Dividend Election With Respect to a Section 1297(e) PFIC. I, a sbateholde of a MCI& 1297(e) PFIC. within the meaning cf Regulations sec= 1.1297.3(4 elect to non a teemed divieend efection with respect to the Seaton 1297(e) PFIC. My holding period in the stock of the Section 1297(4) PFIC includes the CFC quark:alien date, as deemed In Reputations mew 1.12,37-3(d). Enter the excess distribution on Me 15e, Part V If the excess dIstnbutico is greater than zero, also complete one 16, Part V. Deemed Dividend Election With Respect to a Former PFIC. I, a shareholder 0a former PK, within the meaning of Reetituons section 1.1298-31e), H ri elect to make a &ernes dividend election with respect to the former PFIC. My holding period in the stock of the former PF IC incbdes the larrination date, as defined in Regulations section 1.1298-3(4 Enter the excess distribution an Me 15e, Part V. If the excess arrstribvtitin it greater than zero, also complete tine 16, Pm V. Lma For Disclosure, Privacy Act, and Paperwork Redagoe Act Notice, see separate instructions. Form 8621(Rev. 12012) 15 EFTA00619958