Form Dtf-686-Att - New York Reportable Transaction Disclosure Statement And Request For A Determination - New York State Department Of Taxation And Finance Page 2

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DTF-686-ATT (2012) (back)
6 Facts
a Identify the type of tax benefit generated by the transaction. Mark an X in the boxes that apply
.
( see instructions )
Deductions
Exclusions from gross income
Tax credits
Other
Capital loss
Nonrecognition of gain
Deferral
Ordinary loss
Adjustments to basis
Absence of adjustments to basis
b Further describe below the amount and nature of the expected tax benefits generated by the transaction for all affected years.
Include facts of each step of the transaction that relate to the expected tax benefits including the amount and nature of your
investment. Include in your description your participation in the transaction and all related transactions regardless of the year
in which they were entered into.
7 Identify all tax exempt, foreign, and related entities and individuals involved in the transaction. Mark an X in the appropriate box(es)
. Include their name(s), identifying number(s), address(es), and a brief description of their involvement. For each
( see instructions )
foreign entity, identify its country of incorporation or existence. For each related entity, explain how it is related. Attach additional
sheets if necessary. Include your name and identifying number on all attached sheets.
a Type of entity:
Tax-exempt
Foreign
Related
Name
Identifying number
Address
Description
b Type of entity:
Tax-exempt
Foreign
Related
Name
Identifying number
Address
Description
687002120094

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