Fillable Form 13976 - Itemized Statement Component Of Advisee List (Page 5 of 6) in pdf

Page 5 of 6

General Instructions

Purpose of the Form

Section II - Reportable Transaction Information

Name of Reportable Transaction. Enter the name, if any, by

Note. The use of this Form (or a similar form) is voluntary.

which the transaction is known or commonly referred to by

The use of this Form is not required in order to comply with

either the material advisor or published guidance. If no name

section 6112.

exists, leave blank. Do not report more than one type of

As per Regulations section 301.6112-1(b)(1) and Rev.

reportable transaction on this Form unless the transactions are

Proc. 2008-20, this Form provides material advisors a

the same or substantially similar.

format for preparing and maintaining the itemized

statement component of the list with respect to a

Type of Reportable Transaction. Enter the type of

reportable transaction. This Form contains space for all

reportable transaction that is being reported. The types of

of the elements required by Regulations section

reportable transactions are: listed transactions, confidential

301.6112-1(b)(3)(i), as revised on August 3, 2007.

transactions, transactions with contractual protection, loss

transactions, and transactions of interest. See Regulations

Material advisors may use this Form as a template for

sections 1.6011-4(b)(2)-(6) for the descriptions of the

creating a similar form, including a spreadsheet, on a

reportable transactions. Prior reportable transactions include

software program used by the material advisor.

transactions with a significant book-tax difference and

transactions with a brief asset holding period.

If a material advisor is required to maintain a list under a

prior version of the regulations, this Form may be

Reportable Transaction Number. If you disclosed the

modified or a similar form containing all the information

transaction as a reportable transaction under section 6111,

required under the prior version of the regulations may

enter the reportable transaction number issued to you.

be created and used.

Published Guidance Number. If the transaction is a listed

transaction or transaction of interest, enter the notice, revenue

Use of the Form

ruling, regulation, announcement, or other published guidance

Material advisors may use this Form (or a similar form)

that identified the transaction as a listed transaction or

and provide this Form (or a similar form), along with a

transaction of interest (For example, Notice 2003-81, 2003-51

description of the transaction and copies of documents

I.R.B. 1 modified and supplemented by Notice 2007-71,

required under Regulations section 301.6112-1(b)(3)(ii)

2007-35 I.R.B. 472.). For listed transactions, identify the

and (iii), respectively, when timely furnishing the list in

guidance as shown in Notice 2004-67, 2004-50 I.R.B. 967 or

response to a written request for the list.

later IRS guidance.

Section III - Other Material Advisors to the

Specific Instructions

Reportable Transaction

How to Complete the Form

Enter the names of other material advisors to the transaction, if

In order to be considered complete, this Form (or a similar

known. Use more than one page if necessary.

form) must be completed in its entirety. To be considered

complete, the information provided on this Form (or similar

Individuals. If any other material advisor is an individual,

form) must include a summary or schedule of the tax treatment

enter the last name and first name, the complete address, and

that the advisee is intended or expected to derive from

the social security number (if known) of the material advisor.

participation in the reportable transaction. A statement that

Indicate with a "yes" or "no" whether the other material advisor

information will be provided upon request is not considered a

is a party to a designation agreement with respect to the

complete Form. If the list is being maintained under a prior

transaction.

version of Regulations section 301.6112-1, the Form must

contain all of the information required under the prior version in

Entities. If any other material advisor is an entity, enter the

order to be complete.

full name of the entity as shown on its income tax return, the

employer identification number (if known), and the complete

If the information required exceeds the space provided,

address. Indicate with a "yes" or "no" whether the other

complete as much information as possible in the available

material advisor is a party to a designation agreement with

space and attach the remaining information on additional

respect to the transaction.

sheets. The additional sheets must be in the same order as

the lines to which they correspond and should be clearly

Caution: The designation of one material advisor to disclose

labeled to identify the Section of the Form to which they

the transaction does not relieve you from the requirements of

correspond. You must include your name and identifying

Regulations section 301.6112-1 if the IRS is unable to obtain

number at the top of each additional sheet.

the list from the designated material advisor, the designated

material advisor did not maintain a list, or the list maintained by

Section I - Material Advisor Information

the designated material advisor is incomplete.

Individuals. If the material advisor is an individual, enter the

last name and first name, the complete address, the phone

number, and the social security number of the material advisor.

Entities. If the material advisor is an entity, enter the full name

of the entity as shown on its income tax return, the complete

address, the employer identification number, and the name of

a contact person along with a contact telephone number.

13976

Catalog Number 51488Y

Form

(Rev. 04-2008)

Form 13976 - Itemized Statement Component Of Advisee List Page 5

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