Form 8975 - Country By Country Report
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1
28975
Country-by-Country Report
Form
OMB No. 1545-2272
For reporting period beginning
, 20
, and ending
, 20
(June 2017)
Department of the Treasury
Information about Form 8975 and its separate instructions is at
▶
Internal Revenue Service
If this is an amended report, check here
Enter the number of Schedules A (Form 8975) attached to this Form 8975 ▶
Part I
Identification of Filer
1a Name of the reporting entity
1b Reporting role code
1c EIN
2
Number, street, and room or suite no. (if P.O. box, see instructions)
3a City or town
3b State or province
3c Country, and ZIP or foreign postal code
Part II
Additional Information
Enter any additional information related to the multinational enterprise group.
8975
For Paperwork Reduction Act Notice, see separate instructions.
Form
(6-2017)
Cat. No. 37798N
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