Corporate and Real Estate Investment Trust (REIT) Report of Net 965  
Form  965-B                                                                                                                                                                                        OMB No. 1545-0123
(Rev. January 2020)                                   Tax Liability and Electing REIT Report of 965 Amounts
Department of the Treasury                                      ▶ Go to www.irs.gov/Form965B for instructions and the latest information.
Internal Revenue Service
Check this box if this is an amended report           .     .   . .    .          . . . .   .  .    .     . . .  .     . .  .  .  .      . . .        . . .   . .   .     .   .        . . . . .   . .         .   . ▶
Name of taxpayer or REIT                                                                                                                                  Identifying number                 Taxable year of reporting

REITs Electing To Account for Section 965 Amounts Over Time Must Fill Out Part III.
Part I      Report of Net 965 Tax Liability and Election To Pay in Installments 
        (a)                   (b)                           (c)                           (d)                 (e)                 (f)                           (g)                            (h)                    (i) 
      Year of          Taxpayer’s Net Tax Liability  Taxpayer’s Net Tax Liability   Net 965 Tax Liability   Installment     Net 965 Tax Liability       Net 965 Tax Liability            Net 965 Tax Liability       Tax 
      Section                                                                                                                                                                                                      Identification 
      965(a)                 With all                 Without                       (subtract column (c)      Election   To Be Paid in Full in Year 1   To Be Paid in Installments         Transferred (Out),        Number 
  Inclusion or             965 Amounts              965 Amounts                       from column (b))        Made       (if column (e) is “No,” enter  (if column (e) is “Yes,” enter     Transferred In, or        of Buyer/
      Liability          (see instructions)         (see instructions)                                                      amount from column (d))     amount from column (d)           Subsequent Adjustments,   Transferee or 
      Assumed                                                                                                                                           and see instructions)            if any (see instructions)   Seller/ 
  (see instructions)                                                                                        Yes   No                                                                                                 Transferor   
1      2017
2      2018
3      2019
4
5
6
7
8
Part II     Record of Amount of Net 965 Tax Liability Paid by the Taxpayer (see instructions) 
                (a) 
      Year of Section 965(a)                    (b)                                     (c)                                 (d)                                 (e)                                           (f) 
          Inclusion or                      Paid for Year 1                         Paid for Year 2                      Paid for Year 3                    Paid for Year 4                        Paid for Year 5
        Liability Assumed 
        (see instructions)
1            2017
2            2018
3            2019
4
5
6
7
8
                         (g)                                      (h)                                           (i)                                       (j)                                        (k) 
                       Paid for Year 6                      Paid for Year 7                                 Paid for Year 8                         Net 965 Tax Liability                      Net 965 Tax Liability 
                                                                                                                                           Remaining Unpaid (see instructions)               Paid for the Reporting Year
1
2
3
4
5
6
7
8
Totals  . .     .      . .  . .        . .  . . .   . .     .   . .    .          . . . .   .  .    .     . . .  .     . .  .  .  ▶
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                                                       Cat. No. 71278S                                           Form 965-B (Rev. 1-2020)

Form 965-B (Rev. 1-2020)                                                                                                                                           Page 2
Part III Electing REIT Report of Section 965 Amounts Accounted for Over Time (see instructions)
             (a)                              (b)                             (c)                         (d)                  (e)                           (f) 
           Tax Year of                  Amount Elected To Be           Portion Accounted for in       Portion Accounted for in Portion Accounted for in Portion Accounted for in 
       Section 965(a) Inclusion and     Accounted for Over Time            Year 1                         Year 2               Year 3                        Year 4
         Section 965(c) Deduction
1a 2017  Section 965(a) Inclusion
1b 2017  Section 965(c) Deduction
2a 2018  Section 965(a) Inclusion
2b 2018  Section 965(c) Deduction
3a 2019  Section 965(a) Inclusion
3b 2019  Section 965(c) Deduction
             (g)                              (h)                             (i)                           (j)                (k)                           (l) 
         Portion Accounted for in       Portion Accounted for in       Portion Accounted for in       Portion Accounted for in Amount Remaining To Be   Portion Accounted for 
             Year 5                           Year 6                       Year 7                         Year 8               Accounted for            in This Reporting Year
1a
1b
2a
2b
3a
3b

Totals . . . . .         . .      . . . . . . .   .  . .         . . . . . .  .   . . .         . . . . . . .    . . .  ▶
If more lines are needed for any Parts on this form, attach additional sheets.
                                                                                                                                                        Form 965-B (Rev. 1-2020)