Fillable Form 8275-R - Regulation Disclosure Statement printable pdf download

Form 8275-R - Regulation Disclosure Statement

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8275-R

Regulation Disclosure Statement

OMB No. 1545-0889

Form

Use this form only to disclose items or positions that are contrary to Treasury

(Rev. August 2013)

regulations. For other disclosures, use Form 8275, Disclosure Statement.

Attachment

Information about Form 8275-R and its separate instructions is at

92A

▶

Sequence No.

Department of the Treasury

Attach to your tax return.

Internal Revenue Service

▶

Identifying number shown on return

Name(s) shown on return

If Form 8275-R relates to an information return for a foreign entity (for example, Form 5471), enter:

Name of foreign entity

▶

Employer identification number, if any

▶

Reference ID number (see instructions)

▶

Part I

General Information (see instructions)

(b)

(c)

(d)

(e)

(a)

(f)

Item or Group

Detailed Description

Form or

Line

Regulation Section

Amount

of Items

Schedule

No.

Part II

Detailed Explanation (see instructions)

Part III

Information About Pass-Through Entity. To be completed by partners, shareholders, beneficiaries,

or residual interest holders.

Complete this part only if you are making adequate disclosure for a pass-through item.

Note: A pass-through entity is a partnership, S corporation, estate, trust, regulated investment company (RIC), real estate investment

trust (REIT), or real estate mortgage investment conduit (REMIC).

2 Identifying number of pass-through entity

Name, address, and ZIP code of pass-through entity

3 Tax year of pass-through entity

4 Internal Revenue Service Center where the pass-through entity filed

its return

8275-R

For Paperwork Reduction Act Notice, see separate instructions.

Form

(Rev. 8-2013)

Cat. No. 14594X

Form 8275-R - Regulation Disclosure Statement

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