Form 8858 - Information Return Of U.s. Persons With Respect To Foreign Disregarded Entities Page 2

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2
Form 8858 (Rev. 12-2013)
Page
Schedule C
Income Statement (see instructions)
Important: Report all information in functional currency in accordance with U.S. GAAP. Also, report each amount in U.S.
dollars translated from functional currency (using GAAP translation rules or the average exchange rate determined under
section 989(b)). If the functional currency is the U.S. dollar, complete only the U.S. Dollars column. See instructions for
special rules for foreign disregarded entities that use DASTM.
If you are using the average exchange rate (determined under section 989(b)), check the following box . . . . . .
Functional Currency
U.S. Dollars
1
1
Gross receipts or sales (net of returns and allowances) .
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2
Cost of goods sold .
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2
3
Gross profit (subtract line 2 from line 1) .
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3
4
4
Other income.
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5
Total income (add lines 3 and 4)
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5
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Total deductions
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6
7
7
Other adjustments .
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8
Net income (loss) per books .
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8
Schedule C-1
Section 987 Gain or Loss Information
(a)
(b)
Note. See the instructions if there are multiple recipients of remittances
Amount stated in
Amount stated in
from the foreign disregarded entity.
functional currency of
functional currency of
foreign disregarded entity
recipient
1
Remittances from the foreign disregarded entity .
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1
2
2
Section 987 gain (loss) of recipient
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Yes
No
3
Were all remittances from the foreign disregarded entity treated as made to the direct owner? .
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4
Did the tax owner change its method of accounting for section 987 gain or loss with respect to remittances
from the foreign disregarded entity during the tax year? .
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Schedule F
Balance Sheet
Important: Report all amounts in U.S. dollars computed in functional currency and translated into U.S. dollars in
accordance with U.S. GAAP. See instructions for an exception for foreign disregarded entities that use DASTM.
(a)
(b)
Assets
Beginning of annual
End of annual
accounting period
accounting period
1
1
Cash and other current assets .
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2
Other assets .
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2
3
Total assets .
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3
Liabilities and Owner’s Equity
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Liabilities .
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4
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Owner’s equity .
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5
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Total liabilities and owner’s equity .
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Schedule G
Other Information
Yes
No
1
During the tax year, did the foreign disregarded entity own an interest in any trust?.
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2
During the tax year, did the foreign disregarded entity own at least a 10% interest, directly or indirectly, in
any foreign partnership? .
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3
Answer the following question only if the foreign disregarded entity made its election to be treated as
disregarded from its owner during the tax year: Did the tax owner claim a loss with respect to stock or
debt of the foreign disregarded entity as a result of the election? .
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4
If the interest in the foreign disregarded entity is a separate unit under Reg. 1.1503(d)-1(b)(4) or part of a
combined separate unit under Reg. 1.1503(d)-1(b)(4)(ii) does the separate unit or combined separate unit
have a dual consolidated loss as defined in Reg. 1.1503(d)-1(b)(5)(ii)? .
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If “Yes,” enter the amount of the dual consolidated loss
Answer question 5a.
$
▶
8858
Form
(Rev. 12-2013)

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