SCHEDULE C Foreign Tax Redeterminations (Form 1116) (Rev. December 2022) For calendar year 20 , or other tax year beginning , 20 , and ending , 20 . OMB No. 1545-0121 Department of the Treasury See separate instructions. Internal Revenue Service Go to www.irs.gov/Form1116 for instructions and the latest information. Name Identifying number as shown on page 1 of your tax return Use a separate Schedule C (Form 1116) for each applicable category of income listed below. See instructions. Check only one box on each schedule. a Section 951A category income c Passive category income e Section 901(j) income g Lump-sum distributions b Foreign branch category income d General category income f Certain income re-sourced by treaty h If box e is checked, enter the country code for the sanctioned country. See instructions . . . . . . . . . . . . . . . . . . . . . . . i If box f is checked, enter the country code for the treaty country. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . Part I Increase in Amount of Foreign Taxes Accrued (see instructions) Enter redetermined amounts by payor for each separate relation back year (starting with the most recent) followed by a subtotal for each relation back year. 1. U.S. Tax Year 2a. Name of Payor 2b. EIN or Reference ID Number 3. Country or 4. Date 5. Foreign of Taxpayer to (see instructions) of Payor U.S. Possession Additional Tax Year Which Tax Relates to Which Tax Foreign Tax to Which (relation back year) Is Paid Was Paid Tax Relates (MM/DD/YYYY) (enter code— (MM/DD/YYYY) (MM/DD/YYYY) see instructions) (1) A (2) (3) (1) B (2) (3) 6. Payor’s Income 7. Additional Tax 8. Additional Tax 9. Conversion Rate 10. Additional Tax 11. U.S. Dollar 12. Revised Tax Accrued 13. Reference ID Number Subject to Tax in the Accrued in Accrued in of Local Currency Accrued in Tax of Payor (add column 10 for Contested Tax, Foreign Jurisdiction Local Currency Functional Currency to U.S. Dollars U.S. Dollars Reported on and column 11) if Applicable (see instructions) in Which the of Payor (divide column 7 Original/Amended Return (see instructions) Tax Is Payable by column 9) (1) A (2) (3) Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) .. . . . . . . . . . . . . . . . . (1) B (2) (3) Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) . . . . . . . . . . . . . . . . . . For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 75187Q Schedule C (Form 1116) (Rev. 12-2022) |
Schedule C (Form 1116) (Rev. 12-2022) Page 2 Part II Decrease in Amount of Foreign Taxes Paid or Accrued (see instructions) Enter redetermined amounts by payor for each separate relation back year (starting with the most recent) followed by a subtotal for each relation back year. 1. U.S. Tax Year 2a. Name of Payor 2b. EIN or 3. Country or 4. Date 5. Foreign of Taxpayer to (see instructions) Reference ID Number U.S. Possession Foreign Tax Tax Year Which Tax Relates of Payor From Which Tax Was Refunded to Which (relation back year) Was Refunded or Deemed Tax Relates (MM/DD/YYYY) or Deemed Refunded (MM/DD/YYYY) Refunded (MM/DD/YYYY) (enter code— (see instructions) see instructions) (1) A (2) (3) (1) B (2) (3) 6. Payor’s Income 7. Tax Refunded 8. Refunded Amount 9. Conversion Rate 10. Refunded Amount 11. U.S. Dollar Tax 12. Revised Tax 13. Check Box if Subject to Tax in the or Deemed Refunded in Functional Currency of Local Currency in U.S. Dollars of Payor Reported on Paid or Accrued Section 905(c)(2) Foreign Jurisdiction in Local Currency in of Payor to U.S. Dollars (divide column 7 Original/Amended Return (subtract column 10 Two Year Rule (see instructions) Which the Tax Is Payable by column 9) from column 11) Applies (see instructions) (1) A (2) (3) Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) . . (1) B (2) (3) Subtotal by Relation Back Year of Taxpayer (add amounts in columns 10, 11, and 12) . . Part III Change in Foreign Taxes Paid or Accrued Enter the information below for the change to the total amount of foreign taxes paid or accrued and the foreign tax credits (FTCs) claimed for each relation back year. 1. Relation Back Year 2. Redetermined Foreign Taxes 3. Foreign Taxes Paid or Accrued 4. Amount of FTC Claimed 5. Amount of FTC Claimed (MM/DD/YYYY) Paid or Accrued per Original/Amended Return per Original/Amended Return After Redetermination A B Part IV Change in U.S. Tax Liability Enter the information below for the change in U.S. tax liability for each relation back year and other affected year (see instructions). 1. Relation Back Year or Affected Tax Year 2. Total Redetermined 3. Total U.S. Tax Liability 4. Difference (MM/DD/YYYY) U.S. Tax Liability per Original/Amended Return (subtract column 3 from column 2) A B Schedule C (Form 1116) (Rev. 12-2022) |
Schedule C (Form 1116) (Rev. 12-2022) Page 3 Part V Annual Reporting for Contested Taxes—Do Not Complete Part V For Tax Year 2022 Beginning with the 2023 tax year, taxpayers will enter the information below for each contested foreign tax liability for which the taxpayer has previously made an election under Regulations section 1.905-1(d)(4) to claim a provisional foreign tax credit. 4. Country or 1. Relation Back Year 2. Name of Payor 3. Reference ID Number U.S. Possession (MM/DD/YYYY) (see instructions) for the Contested Tax to Which Tax Was Paid (enter code— see instructions) (1) (2) (3) (4) (5) 5. Amount of Contested Tax 6. Contest 7. Contest 8. Date Contest 9. Tax Refunded or Provisionally Claimed as Credit Ongoing Resolved Resolved Additional Tax Paid, if Any (MM/DD/YYYY) (see instructions) (1) (2) (3) (4) (5) Schedule C (Form 1116) (Rev. 12-2022) |