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TLS, have you I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
transmitted all R Action Date Signature
text files for this INSTRUCTIONS TO PRINTERS
FORM 8895, PAGE 1 of 2
cycle update? MARGINS: TOP 13mm (1⁄ "),2 CENTER SIDES. PRINTS: HEAD to HEAD O.K. to print
PAPER: WHITE WRITING,1 2 SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8 ⁄ ") x 279mm (11")
Date PERFORATE: (NONE) Revised proofs
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT requested

(AugustForm 8895 2005) One-Time Dividends Received Deduction for Certain Cash OMB No. 1545-1948
Dividends from Controlled Foreign Corporations
Department of the Treasury
Internal Revenue Service Attach to the corporation’s tax return.
Name of corporation Employer identification number

Part I Qualifying Information
A Enter the date(s) the corporation’s domestic reinvestment plan(s) (DRP) was approved by the corporation’s
president, CEO, or comparable official , 20 .
B Enter the date(s) the DRP was approved by the corporation’s board of directors, management committee,
executive committee, or similar body , 20 .
C The DRP states that the corporation anticipates completing all reinvestments in the tax year ending
, 20 . See Notice 2005-10 for required attachment.
D Does the corporation have an applicable financial statement (as defined in section 965(c)(1)) that shows a specific
amount of earnings permanently reinvested outside the United States? Yes No
If “Yes,” enter that amount on line 2 below. However, if the corporation is a member of a controlled group
of corporations, see instructions.
If “No,” complete item E below.
E If item D is “No,” does the corporation have an applicable financial statement that shows a specific amount of
tax liability attributable to earnings permanently reinvested outside the United States? Yes No
If “Yes,” divide the tax liability by 0.35 and enter the result on line 2 below. However, if the corporation is a
member of a controlled group of corporations, see instructions.
If “No,” enter -0- on line 2 below.
F Is the corporation required to adjust the amount of its base period inclusions, APB 23 limitation, or related party
indebtedness pursuant to Notice 2005-38? Yes No
Part II Dividends Received Deduction
1 Enter the “cash dividends” that the corporation received from all controlled foreign corporations
(CFCs) during the tax year. See instructions 1
2 Earnings permanently reinvested outside the United States (see items D and E above) 2
3 Section 965(b)(1) limit. Enter the greater of line 2 or $500,000,000. However, if the corporation
is a member of a controlled group of corporations, see instructions 3
4 Section 965(b)(2) base period amount. Enter amount from Part VI, line 51 4
5 Section 965(b)(2) limit. Subtract line 4 from line 1. If zero or less, stop here (see instructions). 5
6 Section 965(b)(4) limit. Amounts to be reinvested in the United States under a DRP 6
7 Enter the smallest of lines 3, 5, and 6 7
8 Enter the amount of CFC indebtedness to any related person as of the
close of the tax year (see instructions) 8
9 Enter the amount of CFC indebtedness to any related person as of the
close of October 3, 2004 (see instructions) 9
10 Section 965(b)(3) limit. Subtract line 9 from line 8. If zero or less, enter -0- 10
11 Qualifying dividends. Subtract line 10 from line 7. If zero or less, stop here (see instructions). If more
than zero, enter the result here and on Form 1120, Schedule C, line 12, column (a) 11
12 Enter all section 965(a)(2) amounts included on line 11 (see instructions) 12
13 Deductible portion of qualifying dividends. Multiply line 11 by 85%. Enter here and on Form
1120, Schedule C, line 12, column (c) 13
14 Expenses disallowed under section 965(d)(2) with respect to line 13 amount 14
15 Nondeductible CFC dividends. Subtract line 13 from line 11. See instructions 15
Part III Regular Tax Liability for Computing Credit Limitations and Alternative Minimum Tax
16 Enter the corporation’s taxable income (Form 1120, line 30) 16
17 Taxable income excluding nondeductible CFC dividends. Subtract line 15 from line 16 17
18 Enter the corporation’s regular tax liability (Form 1120, Schedule J, line 3) 18
19 Tax on nondeductible CFC dividends. Enter the smaller of line 18 or 35% of line 15 19
20 Tax on line 17 amount. Subtract line 19 from line 18 20
21 Foreign tax credit that reduces tax on line 19 (see instructions) 21
22 Subtract line 21 from line 19 22
23 Foreign tax credit that reduces tax on line 20. Subtract line 21 from line 39 23
24 Subtract line 23 from line 20 24
25 Alternative minimum tax (see instructions) 25
For Paperwork Reduction Act Notice, see instructions. Cat. No. 37703U Form 8895 (8-2005)

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                                                                                                    15
                                 I.R.S. SPECIFICATIONS             TO BE REMOVED BEFORE PRINTING
                                 INSTRUCTIONS TO PRINTERS 
                                 FORM 8895, PAGE 2 of 2 
                                 MARGINS: TOP 13mm (1⁄ "),2 CENTER SIDES.       PRINTS: HEAD TO HEAD
                                 PAPER: WHITE WRITING, SUB. 20.               INK: BLACK 
                                 FLAT SIZE: 216mm (81⁄ ")2  279mm (11") 
                                 PERFORATE: NONE
                                 DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8895 (8-2005)                                                                                                             Page       2
Part IV Foreign Tax Credit—Additional Limitation for Separate Categories With Nondeductible CFC
        Dividends (see instructions)
26 Enter the name of the separate category
27 Enter the amount of nondeductible CFC dividends in the separate category                                       27
28 Subtract line 27 from the amount on Form 1118, Schedule B, Part II, line 6                                     28
29 Subtract line 27 from the amount on Form 1118, Schedule B, Part II, line 7c                                    29
30 Divide line 28 by line 29                                                                                      30
31 Enter 35% of line 27                                                                                           31
32 Subtract line 31 from the amount on Form 1118, Schedule B, Part II, line 9                                     32
33 Multiply line 30 by line 32                                                                                    33
34 Enter foreign taxes paid or accrued with respect to line 27 amount                                             34
35 Add lines 33 and 34                                                                                            35
36 Enter the credit computed for the separate category on Form 1118, Schedule B, Part III                         36
37 Enter the smaller of line 35 or line 36                                                                        37
38 Enter the smaller of line 31 or line 34                                                                        38
39 Enter the corporation’s revised foreign tax credit for all separate categories (see instructions)              39
Part V  Schedule of Dividends (see instructions)
                                                                        (c)                         (d)                  (e)
                                                               “Cash dividends”                     Check           Column (c)(2) line
                                                                   from CFCs                    box if a  amounts the corporation
                                                           (1)                  (2)             section           specifically identifies 
        (a)                      (b)              Functional                    U.S.            965(a)(2)         as qualifying dividends 
      Name of CFC       Date Paid                 Currency                   Dollars            amount              (see instructions)
40

Totals
Part VI Section 965(b)(2) Base Period Amount (see instructions)
        See instructions if the corporation has fewer than 5 tax years in its base period.
                                              (a)                        (b)                    (c)                      (d)
   Tax Years in Base Period      Section 965(b)(2)(B)(i)       Section 965(b)(2)(B)(ii) Section 965(b)(2)(B)(iii) Total. Add columns (a)
                                            dividends              inclusions            distributions              through (c)
41 Most recent tax year
   ending on or before
   June 30, 2003
42 Tax year prior to line 41 year
43 Tax year prior to line 42 year
44 Tax year prior to line 43 year
45 Tax year prior to line 44 year
46 Add lines 41 through 45, column (d)                                                                  46
47 Enter the largest of lines 41 through 45, column (d)                                                 47
48 Enter the smallest of lines 41 through 45, column (d)                                                48
49 Add lines 47 and 48                                                                                  49
50 Subtract line 49 from line 46                                                                        50
51 Divide line 50 by 3. (See instructions if the corporation has fewer than 5 tax years in its base
   period.) Enter the result here and on page 1, line 4                                                 51
                                                                                                                    Form 8895  (8-2005)

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