Country-by-Country Report
Form  8975
(Rev. December 2020)        For reporting period beginning                 , 20                 , and ending           , 20  OMB No. 1545-2272
Department of the Treasury                  ▶ Go to www.irs.gov/Form8975 for instructions and the latest information.
Internal Revenue Service 
If this is an amended report, check here

Enter the number of Schedules A (Form 8975) attached to this Form 8975   ▶
Part I    Identification of Filer
1a    Name of the reporting entity                                                              1b Reporting role code 1c EIN

2     Number, street, and room or suite no. (if P.O. box, see instructions)

3a    City or town                                             3b  State or province                            3c  Country, and ZIP or foreign postal code

4     Name of the U.S. Multinational Enterprise (MNE) group (if different from reporting entity)

Part II   Additional Information
Enter any additional information related to the U.S. MNE group

For Paperwork Reduction Act Notice, see separate instructions.                                  Cat. No. 37798N              Form 8975 (Rev. 12-2020)

Form 8975 (Rev. 12-2020)                            Page 2
Part II Additional Information (continued)

                                          Form 8975 (Rev. 12-2020)