Form 851 - Affiliations Schedule For Tax Year Ending - 2016 Page 2
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Form 851 (Rev. 10-2016)
Page
Part III
Changes in Stock Holdings During the Tax Year
(b) Shares held after
(a) Changes
changes described in
Share-
column (a)
Date
Corp.
holder of
Name of corporation
of
No.
Corpora-
transaction
Number of
Number of
tion No.
Percentage of
Percentage of
shares
shares
voting power
value
acquired
disposed of
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
(c)
If any transaction listed above caused a transfer of a share of subsidiary stock (defined to include
dispositions and deconsolidations), did the share's basis exceed its value at the time of the transfer? See
instructions .
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Yes
No
(d)
Did any share of subsidiary stock become worthless within the meaning of section 165 (taking into account
the provisions of Regulations section 1.1502-80(c)) during the taxable year? See instructions .
.
.
.
Yes
No
(e)
If the equitable owners of any capital stock shown above were other than the holders of record, provide details of the changes.
(f)
If additional stock was issued, or if any stock was retired during the year, list the dates and amounts of these transactions.
851
Form
(Rev. 10-2016)
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