Department of the Treasury – Internal Revenue Service                                        Tax Year
Form 13586                                      Additional Information and Documentation for Announcement
(May 2004)
                                                       2004-46, Settlement Initiative — 60-Day Response
INSTRUCTIONS — Under penalties of perjury (see Form 13586-A), the taxpayer must submit all information requested on this form to the IRS within 60 days from the date shown on
                          the transmitting Letter 3873.
•       Prepare a Form 13586 for each year you derived a benefit from a Notice 2000-44 (or substantially similar) transaction. This requirement also applies to any year for which the statute
        of limitation for assessment is closed.
•       If more space is needed than what is provided in any area on this form, then attach a separate sheet(s) and print your name, TIN (EIN / SSN), and the tax year at the top. Be sure to
        reference the specific section and line item on all additional sheets.
•       Check the completed form(s) for accuracy and, when more than one year is involved, total all entries before transferring any numbers to the appropriate lines specified on Form
        13586-A, Announcement 2004-46 Settlement Initiative Declaration.
Section I.                                                                        Taxpayer Data
1. Taxpayer name(s)                                              2. Social security number (SSN) 3. Partnership name (Complete Section II, if applicable) 4. Employer identification
                                                                                                                                                          number (EIN)

Section II.                                                                   Additional Related Entities
1.                           Name                                2.           EIN                3.                             Type of Return(s)

Section III.                                                                  Tax Benefits Claimed on Tax Return(s)
              Transactions Reported                                                                                  Tax Return              "x" if not   Additional Entities
1.                    (Loss)                    Amount              Ordinary                     Capital         (Form, Schedule, Line Item) claimed
a.
b.
c.
d.
e.      Total (Losses)
        Other Items Claimed on Return
2.      Income Received / Accrued
        (e.g. Interest, Dividends, etc.)
a.
b.
c.
d.
e.      Total Other Income
        Other Losses Claimed on Return
     3. (e.g., STCL (Net Foreign Currency Loss))
a.
b.
c.      Total Other Losses
Catalog No. 38515U                              Sheet 1 of 2                           www.irs.gov                                                        Form 13586 (5-2004)

Section III. Total Tax Benefits Claimed on Tax Return(s) — continued
    Other Gains Claimed on Return
4.  (e.g., STCG (Net Foreign Currency Gain)) Amount           Ordinary                         Capital           Tax Return                "x" if not Additional Entities
                                                                                                               (Form, Schedule, Line Item) claimed
a.
b.
c.  Total Other Gains
5.  Other Expenses / Deductions
a.  Bank fee
b.  Guaranteed payment fee
c.  Investment interest expense
d.  (Specify.)
e.  Total Other Expenses / Deductions
6.  Total Tax Benefits Claimed on
    Return (Lines 1 - 2 + 3 - 4 + 5 )
Section IV.                                               Net Out of Pocket Costs
1.  Cash contributed
2.  Cost of property contributed
3.  Fees paid  / Accrued directly            Amount           Date                             Paid to (Specify)                                      Tax Return                  "x" if not
    by taxpayer                                               (mmddyyyy)                                                                              (Form, Schedule, Line Item) claimed
a.  Financial Advisor
b.  Accountant / Accounting Firm
c.  Legal Opinions from: (Specify)
    1.
    2.
    3.
d.  Interest expense
e.  Other deductions listed on Sch. A
    1.
    2.
    3.
f.   Other fees (Specify)
    1.
    2.
    3.
g.  Total fees paid this year
4.  Reimbursement of fees for
    this year                                             Section V.                                   Calculation for Distributed Assets Only
5.  Cash distributed                                      1.  Sales price of Distributed Asset
6.  Cost of property distributed                          2.  Cost of property distributed (Section IV, Line 6)
7.  Net Out of Pocket Costs                               3.  Correct Gain / Loss (Lines 1 - 2)
    (Lines 1 + 2 + 3 - 4 - 5 - 6 )
Catalog No. 38515U                           Sheet 2 of 2                         www.irs.gov                                                         Form 13586 (5-2004)