Form 5712                              Election To Be Treated as a 
(Rev. September 2000)               Possessions Corporation Under Section 936                                       OMB No. 1545-0215 
Department of the Treasury            �Do not attach to your tax return—file separately. 
Internal Revenue Service 

                               The corporation named below elects under section 936(e) of the Inter nal 
                         Revenue Code to be treated as a possessions corporation for income tax purposes. 
Name of corporation                                                                        a  Employer identification number 

Number, street, and room or suite no. (If a P.O. box, see instructions)                    b Date of incorporation 

City or town, state, and ZIP code                                                          c Place of incorporation 

d Business code number              e Principal business activity                          f Principal product or service 

g Election takes effect for the tax h Date corporation began business in a U.S. possession i Annual return will be filed for the tax year ending 
  year beginning (month, day, year)                                                          (enter the month or “unknown”) 

                                      Description of each class of stock                                    Number of shares of each class 
                                                                                                                   issued and outstanding 

Submit the following information for each shareholder who owns 10% or more of the issued and outstanding stock of any class: 
     Name of shareholder            Identifying number                  Address              Class of stock Number of shares owned 

Under penalties of perjury, I declare that I have been duly authorized by the above-named corporation to make this election and that the statements made are, to the 
best of my knowledge and belief, true, correct, and complete. 

Signature and title of officer                                                                              Date 
For Paperwork Reduction Act Notice, see instructions on back.                              Cat. No. 12020I          Form  5712 (Rev. 9-2000) 

Form 5712 (Rev. 9-2000)                                                                                                      Page 2 

Instructions                                                       Consolidated Returns 
Section references are to the Inter nal Revenue Code.              A corporation may not join in filing a consolidated return for 
                                                                   any year this election is in effect. 
Purpose of Form 
                                                                   Business Classification 
Form 5712 must be completed by domestic corporations 
that elect to be treated as possessions corporations under         See the Standard Industrial Classification Manual for the 
section 936.                                                       proper code for the product or service. Enter the business 
Important. The corporation must be an “ existing credit            code number, principal business activity, and principal 
claimant” in order to make this election. For details, see         product or service. 
Regulations section 1.936-11 and the Instructions for Form 
5735.                                                              Address 
                                                                   If the Post Office does not deliver mail to the street address 
Who Can Elect                                                      and the corporation has a P.O. box, show the box number 
                                                                   instead of the street address. 
Only domestic corporations that are existing credit claimants 
can elect to be treated as possessions corporations.               Identifying Number 
When To File                                                       For individuals, the identifying number is their social security 
                                                                   number. For all others, it is the employer identification 
File Form 5712 by the due date (including extensions) of the       number. 
first return to which the election will apply. 
                                                                   Signature 
Where To File 
                                                                   This form must be signed by the president, vice president, 
File this form with the Internal Revenue Service Center,           treasurer, assistant treasurer, chief accounting officer, or any 
Philadelphia, PA 19255. File it separately from your regular       other corporate officer (such as tax officer) authorized to 
income tax return.                                                 sign. 
U.S. Possessions 
For purposes of this election, U.S. possessions include            Paperwork Reduction Act Notice. We ask for the 
Puerto Rico and the Virgin Islands.                                information on this form to carry out the Internal Revenue 
                                                                   laws of the United States. You are required to give us the 
Period of Election                                                 information. We need it to ensure that you are complying 
The election applies to the first tax year the election was        with these laws and to allow us to figure and collect the right 
made, and each subsequent tax year unless revoked, and for         amount of tax. 
each tax year the domestic corporation qualifies under             You are not required to provide the information requested 
section 936(a).                                                    on a form that is subject to the Paperwork Reduction Act 
Generally, an election under section 936(a) may be revoked         unless the form displays a valid OMB control number. Books 
during the first 10 years of section 936 status only with the      or records relating to a form or its instructions must be 
consent of the Commissioner. After the 10th year, the              retained as long as their contents may become material in 
Commissioner’s consent is not needed. See section 936(e)(2)        the administration of any Internal Revenue law. Generally, tax 
for more details. Requests to revoke the election should be        returns and return information are confidential, as required by 
sent to the Internal Revenue Service, Attn: Director, Prefiling    section 6103. 
and Technical Guidance, Large and Mid-Size Business                The time needed to complete and file this form will vary 
Division (LM:PFTG), Mint Bldg, 3rd Floor, Room M3-443,             depending on individual circumstances. The estimated 
1111 Constitution Ave., NW, Washington, DC 20224.                  average time is: 
                                                                   Recordkeeping                            4 hr., 32 min. 
Other Forms That May Be Required                                   Learning about the law or 
Form 5712-A                                                        the form                                        35 min. 
                                                                   Preparing and sending the 
Use Form 5712-A, Election and Verification of the Cost             form to the IRS                                 42 min. 
Sharing or Profit Split Method Under Section 936(h)(5), to 
elect either the cost sharing method or the profit split           If you have comments concerning the accuracy of these 
method. These methods allow the possessions corporation            time estimates or suggestions for making this form simpler, 
to share either its costs or its profits with its affiliates. When we would be happy to hear from you. You can write to the 
making either election, attach Form 5712-A to Schedule P           Tax Forms Committee, Western Area Distribution Center, 
(Form 5735). See Form 5712-A for more details.                     Rancho Cordova, CA 95743-0001. Do not send the form to 
                                                                   this address. Instead, see Where To File above. 
Form 5735 
For each year the election is in effect, Form 5735, 
Possessions Corporation Tax Credit (Under Sections 936 and 
30A) must be completed and attached to the corporation’s 
income tax return.