Schedule K (Form 1120-Ic-Disc) - Shareholder'S Statement Of Ic-Disc Distributions - 2014 Page 2

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SCHEDULE K
Shareholder's Statement of IC-DISC Distributions—2014
OMB No. 1545-0123
(Form 1120-IC-DISC)
For calendar year 2014 or tax year
COPY B—
For Shareholder's
beginning
, 2014, ending
, 20
Department of the Treasury
records
Internal Revenue Service
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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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) 2014
Cat. No. 11474A

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