EFTA01222772.pdf

Fom8275 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 wvnv.irs.govrtorm8275. Sequence No. 92 Department of the Treasury Internal Revenue Service ► Attach to your tax return. Name(s) shown on return Identifying number snows 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 P Reference ID number (see instructions) ► Part I General Information (see instructions (b) (o) 08 0) (a) item or Group Detailed Description Form or Line M Rev. Rut, Rev. Proc., etc. Amount of Items of Items Schedule No. 1 2 3 4 5 6 Part II Detailed Explanation (see instructions) 1 2 S 4 5 6 Part III 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 (RE/7), 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. Farm 8275 (Rey. 8-2013) EFTA01222772 Form 8275 (Rev. 8-2013) Page 2 ham Explanations (continued from Parts 1and/or 10 Form 8275 (Rev. 8-2013) EFTA01222773