Form 8886 - Reportable Transaction Disclosure Statement Page 2
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Form 8886 (Rev. 3-2011)
Page
7
Facts
a
Identify the type of tax benefit generated by the transaction. Check all the boxes that apply (see instructions).
Deductions
Exclusions from gross income
Absence of adjustments to basis
Tax Credits
Capital loss
Nonrecognition of gain
Deferral
Ordinary loss
Adjustments to basis
Other
b Further describe the amount and nature of the expected tax treatment and 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. Also, include a description of any tax result protection with respect to the transaction.
8
Identify all individuals and entities involved in the transaction that are tax-exempt, foreign, or related. Check the appropriate box(es) (see
instructions). Include their name(s), identifying number(s), address(es), and a brief description of their involvement. For each foreign entity,
identify its country of incorporation or existence. For each individual or related entity, explain how the individual or entity is related. Attach
additional sheets, if necessary.
a
Type of individual or entity:
Tax-exempt
Foreign
Related
Name
Identifying number
Address
Description
b Type of individual or entity:
Tax-exempt
Foreign
Related
Name
Identifying number
Address
Description
8886
Form
(Rev. 3-2011)
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