Form 13586 - Additional Information And Documentation For Announcement 2004-46, Settlement Initiative - 60-Day Response Page 2

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Section III. Total Tax Benefits Claimed on Tax Return
(s) — continued
Other Gains Claimed on Return
Tax Return
"x" if not
4.
Amount
Ordinary
Capital
Additional Entities
(e.g., STCG (Net Foreign Currency Gain))
(Form, Schedule, Line Item)
claimed
a.
b.
c.
Total Other Gains
5.
Other Expenses / Deductions
a. Bank fee
b. Guaranteed payment fee
c. Investment interest expense
d.
(Specify.)
e.
Total Other Expenses / Deductions
Total Tax Benefits Claimed on
6.
Return
(Lines 1 - 2 + 3 - 4 + 5 )
Section IV.
Net Out of Pocket Costs
1. Cash contributed
2. Cost of property contributed
Fees paid / Accrued directly
"x" if not
Date
Tax Return
3.
Amount
Paid to
(Specify)
by taxpayer
claimed
(mmddyyyy)
(Form, Schedule, Line Item)
a. Financial Advisor
b. Accountant / Accounting Firm
c.
Legal Opinions from: (Specify)
1.
2.
3.
d. Interest expense
e. Other deductions listed on Sch. A
1.
2.
3.
f. Other fees
(Specify)
1.
2.
3.
g.
Total fees paid this year
Reimbursement of fees for
Section V.
Calculation for Distributed Assets Only
4.
this year
5. Cash distributed
1. Sales price of Distributed Asset
6. Cost of property distributed
2. Cost of property distributed
(Section IV, Line 6)
Net Out of Pocket Costs
3. Correct Gain / Loss
(Lines 1 - 2)
7.
(Lines 1 + 2 + 3 - 4 - 5 - 6 )
Catalog No. 38515U
Sheet 2 of 2
13586
Form
(5-2004)

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