Form 8806 - Information Return For Acquisition Of Control Or Substantial Change In Capital Structure - 2003

Download a blank fillable Form 8806 - Information Return For Acquisition Of Control Or Substantial Change In Capital Structure - 2003 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 8806 - Information Return For Acquisition Of Control Or Substantial Change In Capital Structure - 2003 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Information Return for Acquisition of Control

8806

Form

or Substantial Change in Capital Structure

OMB No. 1545-1869

(December 2003)

Department of the Treasury

Internal Revenue Service

Part I

Reporting Corporation (see instructions)

Name of reporting corporation

Address of reporting corporation

c EIN of reporting corporation

Name of reporting corporation’s common parent, if any

Address of reporting corporation’s common parent

c EIN of reporting corporation’s common parent

Part II

Acquiring Corporation (see instructions)

3a Name of acquiring corporation

Address of acquiring corporation

c EIN of acquiring corporation

Is the acquiring corporation a foreign corporation (as defined in section 7701(a)(5))?

Yes

Is the acquiring corporation a dual resident corporation (see Regulations section 1.1503-2(c)(2))?

Yes

Was the acquiring corporation newly formed prior to its involvement in the transaction?

Yes

4a Name of acquiring corporation’s common parent, if any

Address of acquiring corporation’s common parent

c EIN of acquiring corporation’s common parent

Part III

Information About Acquisition of Control or Substantial Change in Capital Structure

5a Date of transaction(s) that resulted in the acquisition of control or substantial change in capital structure

b Description of the transaction(s)

6a Did the reporting corporation’s shareholders receive any stock in exchange for their stock in the reporting

corporation, for which the reporting corporation has reasonably determined that the shareholders are not required to

recognize gain (if any) from the receipt of such stock? (If “No,” go to line 7a)

Yes

b Fair market value of the stock received

c Description of the stock received

7a Amount of cash received by the reporting corporation’s shareholders in exchange for their stock

b Fair market value of property, other than stock, received by the reporting corporation’s shareholders

c Did the reporting corporation’s shareholders receive any stock, other than stock described on line 6c above, in exchange

for their stock in the reporting corporation, for which the reporting corporation has reasonably determined that its

shareholders would be required to recognize gain (if any) from the receipt of such stock? (If “No,” go to line 7e.)

Yes

d Fair market value of the stock received

e Total cash and property. Add lines 7a, 7b, and 7d

Description of the stock

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,

correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign

Here

Signature of officer

Date

Preparer’s SSN or PTIN

Paid

Preparer’s

Check if

signature

self-employed

Preparer’s

Firm’s name (or

EIN

Use Only

yours if self-employed),

Phone no.

(

)

address, and ZIP code

Part IV

Consent Election

Does the reporting corporation consent to the publication of its name and address, date of transaction(s), description of shares

affected by the transaction(s) and the amount of cash and fair market value of any property provided to each class of shareholders in

exchange for a share, on an IRS website and/or in an IRS publication, as described in Temporary Regulations section 1.6043-4T(a)(2),

Yes

to assist brokers to satisfy their reporting obligations under Temporary Regulations section 1.6045-3T?

Under penalties of perjury, I declare that I am an officer of the above named corporation and that I am authorized to give consent on behalf of the above named

corporation for the IRS to publish the information necessary to enable brokers to satisfy their reporting obligations under Temporary Regulations section 1.6045-3T.

Sign

Here

Signature of officer

Date

Title

8806

For Paperwork Reduction Act Notice, see page 3.

Cat. No. 10085T

Form

(12-2003)