Form 8937 - Report Of Organizational Actions Affecting Basis Of Securities
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1
28937
Report of Organizational Actions
Form
Affecting Basis of Securities
OMB No. 1545-2224
(December 2011)
Department of the Treasury
See separate instructions.
▶
Internal Revenue Service
Part I
Reporting Issuer
1 Issuer's name
2 Issuer's employer identification number (EIN)
3 Name of contact for additional information
4 Telephone No. of contact
5 Email address of contact
6 Number and street (or P.O. box if mail is not delivered to street address) of contact
7 City, town, or post office, state, and Zip code of contact
8 Date of action
9 Classification and description
10 CUSIP number
11 Serial number(s)
12 Ticker symbol
13 Account number(s)
Part II
Organizational Action
Attach additional statements if needed. See back of form for additional questions.
14
Describe the organizational action and, if applicable, the date of the action or the date against which shareholders' ownership is measured for
the action
▶
15
Describe the quantitative effect of the organizational action on the basis of the security in the hands of a U.S. taxpayer as an adjustment per
share or as a percentage of old basis
▶
16
Describe the calculation of the change in basis and the data that supports the calculation, such as the market values of securities and the
valuation dates
▶
8937
For Paperwork Reduction Act Notice, see the separate Instructions.
Form
(12-2011)
Cat. No. 37752P
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