Form 1120-Ic-Disc - Shareholder'S Statement Of Ic-Disc Distributions - 2012

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SCHEDULE K
Shareholder's Statement of IC-DISC Distributions—2012
OMB No. 1545-0938
(Form 1120-IC-DISC)
For calendar year 2012 or tax year
COPY A—Attach to
beginning
, 2012, ending
, 20
Form 1120-IC-DISC
Department of the Treasury
Internal Revenue Service
(Complete for each shareholder. See instructions on back of Copy C.)
Part I
Taxable Distributions
1
Deemed distributions: a Under section 995(b)(1)
1a
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b Annual installment under section 995(b)(2) .
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1b
c Total. Add lines 1a and 1b .
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1c
2
2
Actual taxable distributions .
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3
Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .
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3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .
4a
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b Part of line 3 above not entitled to section 243 dividends-received deduction
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4b
Section B—Shareholders Other Than C Corporations
5
Amount of taxable dividends included on line 3
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5
Part II
Nontaxable Distributions
6
Actual distributions from previously taxed income and accumulated pre-1985 DISC income
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6
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Other actual nontaxable distributions .
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7
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Total nontaxable distributions. Add lines 6 and 7 .
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8
Part III
Other Information
9
Accumulated IC-DISC income attributable to stock sold during the year .
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9
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Deferred DISC income. See instructions .
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10
Name, employer identification number, and address (including ZIP code)
Shareholder’s name, identifying number, and address (including ZIP code)
of IC-DISC, former DISC, or former IC-DISC
Schedule K (Form 1120-IC-DISC) 2012
IRS.gov/form1120icdisc
Cat. No. 11474A
For Paperwork Reduction Act Notice, see the instructions for Form 1120-IC-DISC.

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