Asset Allocation Statement
Under Section 338
OMB No. 1545-1806
Department of the Treasury
Attach to your income tax return.
See separate instructions.
Internal Revenue Service
Filer’s Identifying Information
Name as shown on return
Identifying number as shown on return
Check applicable box (see instructions):
Was a valid and timely Form 8023 filed?
If yes, enter the date filed
Other Party’s Identifying Information
2a Name of other party to the transaction
Other party’s identifying number
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
Target Corporation’s Identifying Information
3a Name and address of target corporation
Employer identification number
3c State or country of incorporation
4a Acquisition date
4b What percentage of target corporation stock was
During the 12-month acquisition period?
On the acquisition date?
5a Stock price
5b Acquisition costs/Selling costs
5c Target liabilities
Was the filer listed in Part I, above, a member of an affiliated group of corporations before the acquisition date?
Was the target corporation a member of an affiliated group before the acquisition date?
Is the target corporation or any target affiliate:
a A controlled foreign corporation? If “No,” check here if it was a CFC at any time during the preceding 5 years
b A foreign corporation with income, gain, or loss effectively connected with the conduct of a trade or business within
the United States (including U.S. real property interests)?
c A qualifying foreign target under Regulations section 1.338-2(e)(1)(iii)?
A corporation electing under section 1504(d) or section 953(d)?
A domestic international sales corporation (DISC)?
A passive foreign investment company (PFIC)?
If the answer to item 8f is “Yes,” is the PFIC a pedigreed qualified electing fund?
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 33707Y