EFTA01220952.pdf

Fenn 8275 Disclosure Statement Do not use this form to disclose items or positions that are contrary to Treasury OMB No. 1545-0889 regulations. Instead, use Form 8275-R, Regulation Disclosure Statement. (Rev. August 2013} Attachment . Information about Form 8275 and its separate instructions Is at wwwirs.gov/form8275. Sequence "Jo 92 Department of the Treasury Internal Revenue Service ► Attach to your tax return. Name(s) shown on return Identifying number shown on return If Form 8275 relates to an information return for a foreign entity (for example, Form 5471), enter. Name of foreign entity P. Employer identification number, if any► Reference ID number (see instructions)P. Part I General Information (see instructions OH (c) (G) (e) (a) Item or Group Detailed Description Form or Line M Rev. Rut, Rey. Proc., etc. of Items of items Schedule No. Amount 1 2 3 4 5 6 Part II Detailed Explanation (see instructions) 1 2 S 4 6 6 Information About Pass-Through Entity. To be completed by partners. shareholders, beneficiaries, or residual interest holders. Complete this part only if you are making adequate disclosure for a pass-through item. Note: A pass-through entity is a partnership, S corporation, estate, trust, regulated investment company (RIC), real estate investment trust (REID, or real estate mortgage investment condu t (REMIC). 1 Name, address, and ZIP code of pass-through entity 2 Identifying number of pass-through entity 3 Tax year of pass-through entity to 4 Internal Revenue Service Center where the pass-through entity filed its return For Paperwork Reduction Act Notice, see separate Instructions. Form 8275 (Rev. 8-2013) EFTA01220952 Form 8275 (Rev. 8-2013) Page 2 lama Explanations (continued from Parts I and/or!!) Form 8275 (Rev. 8-2013) EFTA01220953