Form Rev-802 - Schedule C-6 Add-Back For Intangible Expenses Or Cost And Related Interest Page 2

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FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
8020015205
REV-802
PAGE 2 OF 2
REVENUE ID
(02-16)
SCHEDULE C-6 ADD-BACK FOR INTANGIBLE EXPENSES OR COST
AND RELATED INTEREST
TRANSACTIONS WITH UNAFFILIATED ENTITIES
PART III.
1. Unaffiliated Entity Name
Affiliated Entity FEIN
Intangible
Related Interest
Expenses or Cost
Expense or Cost
a. Intangible Expenses Paid to Unaffiliated Entity
1a.
b. Related Interest Expense Paid to Unaffiliated Entity
1b.
c/d. Total Payment Portion Allocation Percentage
1c.
1d.
e/f. Exclusion Amount
1e.
1f.
2. Unaffiliated Entity Name
Affiliated Entity FEIN
Intangible
Related Interest
Expenses or Cost
Expense or Cost
a. Intangible Expenses Paid to Unaffiliated Entity
2a.
b. Related Interest Expense Paid to Unaffiliated Entity
2b.
c/d. Total Payment Portion Allocation Percentage
2c.
2d.
e/f. Exclusion Amount
2e.
2f.
3. Unaffiliated Entity Name
Affiliated Entity FEIN
Intangible
Related Interest
Expenses or Cost
Expense or Cost
a. Intangible Expenses Paid to Unaffiliated Entity
3a.
b. Related Interest Expense Paid to Unaffiliated Entity
3b.
c/d. Total Payment Portion Allocation Percentage
3c.
3d.
e/f. Exclusion Amount
3e.
3f.
4. Unaffiliated Entity Name
Affiliated Entity FEIN
Intangible
Related Interest
Expenses or Cost
Expense or Cost
a. Intangible Expenses Paid to Unaffiliated Entity
4a.
b. Related Interest Expense Paid to Unaffiliated Entity
4b.
c/d. Total Payment Portion Allocation Percentage
4c.
4d.
e/f. Exclusion Amount
4e.
4f.
5. Unaffiliated Entity Name
Affiliated Entity FEIN
Intangible
Related Interest
Expenses or Cost
Expense or Cost
a. Intangible Expenses Paid to Unaffiliated Entity
5a.
b. Related Interest Expense Paid to Unaffiliated Entity
5b.
c/d. Total Payment Portion Allocation Percentage
5c.
5d.
e/f. Exclusion Amount
5e.
5f.
6. TOTAL EXCLUDED
6a.
6b.
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