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PART II
IRS FORM 8938
“STATEMENT OF SPECIFIED FOREIGN FINANCIAL
ASSETS”
(OTHER FOREIGN FINANCIAL ASSETS)
This Section, Part II Applies, For Example, If You Have A Foreign Pension, If You Own Stock In a
Foreign Corporation, including mutual funds held directly with an institution, a Capital or Profits
Interest in a Foreign Partnership, a Note, Bond, Debenture, or Other Form of Indebtedness Issued by
a Foreign Person, an Interest in a Foreign Trust or Foreign Estate, or an Interest in Various Financial
Derivatives or Swaps, or Any Other Foreign Financial Account, an annuity, Life Insurance (cash
value).
1.
YOU MUST LIST ANY FOREIGN FINANCIAL ASSETS IN WHICH YOU HAVE A FINANCIAL INTEREST,
EXCEPT
2.
DO NOT LIST ANY ASSETS THAT ARE INCLUDED IN THE ACCOUNTS LISTED IN PART I
The Potential Penalty Is $10,000 For Failure To Properly Provide The Following Information By The Due Date
Please Attach a Separate Sheet If Needed
Asset #1
Asset #2
Asset #3
Comprehensive Description
(including Description of Class of Stock,
Where Applicable)
________________
_______________
________________
Number or other identifying
information for the asset, if any
________________
_______________
________________
Address
________________
_______________
_________________
If you acquired or sold the
asset during the year – state the date
________________
_______________
________________
Was the asset owned solely by
You or Jointly With Your Spouse
________________
_______________
________________
What was the Maximum
Value of the Asset During the Year
________________
_______________
________________
In What Currency
is the Asset Denominated
________________
________________
_________________
If you have not answered all questions & supplied all documents requested on this organizer, please explain, or call us -
otherwise your tax filing may be delayed, or incorrect, and/or THE ABOVE PENALTIES MAY APPLY.
THIS QUESTIONNAIRE IS FOR OUR INTERNAL USE ONLY - IT WILL NOT GO TO THE IRS
Signed: ___________________________________________
PLEASE RETURN TO: THE BRUNTON – MCCARTHY CPA FIRM CHARTERED
4710 NW BOCA RATON BLVD., #101, BOCA RATON, FL 33431
Tel: (561) 241-9991
Fax: (561) 241-6332
Email:
Website:
Please include a retainer of US $250 with this organizer
If you wish, retainers can be paid on-line with a credit card. Please go to our website and scroll
down to PayPal on the lower right hand side or call our office to take the credit card over the phone.
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