Disclosure Statement                                                    OMB No. 1545-0889 
Form  8275                  Don’t use this form to disclose items or positions that are contrary to Treasury 
(Rev. October 2024)         regulations. Instead, use Form 8275-R, Regulation Disclosure Statement.               Attachment 
Department of the Treasury                Attach to your tax return.                                              Sequence No.  92 
Internal Revenue Service    Go to www.irs.gov/Form8275 for instructions and the latest information.
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  
Employer identification number, if any  
Reference ID number (see instructions) 
Part I   General Information (see instructions) 
         (a)                (b)                                  (c)                                  (d)     (e)        (f) 
Rev. Rul., Rev. Proc., etc. Item or Group                      Detailed Description                   Form or Line  Amount 
                            of Items                             of Items                          Schedule   No.  
1 

2 

3 

4 

5 

6 

Part II  Detailed Explanation (see instructions) 
1 

2 

3 

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 (REIT), or real estate mortgage investment conduit (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.                Cat. No. 61935M                 Form  8275  (Rev. 10-2024) 

Form 8275 (Rev. 10-2024)                                           Page  2 
Part IV Explanations (continued from Parts I and/or II) 

                                                        Form  8275  (Rev. 10-2024)