PDF document
- 1 -
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) 



- 2 -
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) 






PDF file checksum: 2271689463

(Plugin #1/9.12/13.0)