SCHEDULE O Organization or Reorganization of Foreign (Form 5471) Corporation, and Acquisitions and OMB No. 1545-0704 (Rev. December 2012) Dispositions of its Stock Department of the Treasury Information about Schedule O (Form 5471) and its instructions is at www.irs.gov/form5471 Internal Revenue Service ▶ Attach to Form 5471. Name of person filing Form 5471 Identifying number Name of foreign corporation EIN (if any) Reference ID number (see instructions) Important: Complete a separate Schedule O for each foreign corporation for which information must be reported. Part I To Be Completed by U.S. Officers and Directors (a) (b) (c) (d) (e) Name of shareholder for whom Address of shareholder Identifying number Date of original Date of additional acquisition information is reported of shareholder 10% acquisition 10% acquisition Part II To Be Completed by U.S. Shareholders Note: If this return is required because one or more shareholders became U.S. persons, attach a list showing the names of such persons and the date each became a U.S. person. Section A—General Shareholder Information (b) (c) (a) For shareholder’s latest U.S. income tax return filed, indicate: Date (if any) shareholder Name, address, and identifying number of (1) (2) (3) last filed information shareholder(s) filing this schedule Type of return Date return filed Internal Revenue Service Center return under section 6046 (enter form number) where filed for the foreign corporation Section B—U.S. Persons Who Are Officers or Directors of the Foreign Corporation (d) (a) (b) (c) Check appropriate Name of U.S. officer or director Address Social security number box(es) Officer Director Section C—Acquisition of Stock (e) (a) (b) (c) (d) Number of shares acquired Name of shareholder(s) filing this schedule Class of stock Date of Method of acquired acquisition acquisition (1) (2) (3) Directly Indirectly Constructively For Paperwork Reduction Act Notice, see the Instructions for Form 5471. Cat. No. 61200O Schedule O (Form 5471) (Rev. 12-2012) |
Schedule O (Form 5471) (Rev. 12-2012) Page 2 (f) (g) Amount paid or value given Name and address of person from whom shares were acquired Section D—Disposition of Stock (e) (a) (b) (c) (d) Number of shares disposed of Name of shareholder disposing of stock Class of stock Date of disposition Method of disposition (1) (2) (3) Directly Indirectly Constructively (f) (g) Amount received Name and address of person to whom disposition of stock was made Section E—Organization or Reorganization of Foreign Corporation (a) (b) (c) Name and address of transferor Identifying number (if any) Date of transfer (d) Assets transferred to foreign corporation (e) (1) (2) (3) Description of assets transferred by, or notes or Description of assets Fair market value Adjusted basis (if transferor was securities issued by, foreign corporation U.S. person) Section F—Additional Information (a) If the foreign corporation or a predecessor U.S. corporation filed (or joined with a consolidated group in filing) a U.S. income tax return for any of the last 3 years, attach a statement indicating the year for which a return was filed (and, if applicable, the name of the corporation filing the consolidated return), the taxable income or loss, and the U.S. income tax paid (after all credits). (b) List the date of any reorganization of the foreign corporation that occurred during the last 4 years while any U.S. person held 10% or more in value or vote (directly or indirectly) of the corporation’s stock ▶ (c) If the foreign corporation is a member of a group constituting a chain of ownership, attach a chart, for each unit of which a shareholder owns 10% or more in value or voting power of the outstanding stock. The chart must indicate the corporation’s position in the chain of ownership and the percentages of stock ownership (see instructions for an example). Schedule O (Form 5471) (Rev. 12-2012) |