Form 8918 - Material Advisor Disclosure Statement Page 2
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Form 8918 (Rev. 12-2011)
Page
9
Identify the types of financial instruments used in this transaction (see instructions).
Estimated Tax Benefits—Identify the type of tax benefit generated by the transaction that you expect the taxpayer to claim in each year.
10
Check all boxes that apply (see instructions).
Deductions
Exclusions from gross income
Tax credits
Other
Capital loss
Nonrecognition of gain
Deferral
Ordinary loss
Adjustments to basis
Absence of adjustments to basis
11
Timing of Tax Benefits—If you checked one or more boxes on line 10, check the applicable box(es) below to identify the period in which such
tax benefits are claimed. Check each box that applies.
Tax benefits generated by the transaction are required to be claimed in the first year of participation by the taxpayer.
Tax benefits may be claimed in another year by the taxpayer.
12
Enter the Internal Revenue Code section(s) used to claim tax benefit(s) generated by the transaction. (Attach additional sheets if necessary.)
13
Describe the reportable transaction for which you provided material aid, assistance or advice, including but not limited to the following: the
nature of the expected tax treatment and expected tax benefits generated by the transaction for all affected years, the years the tax benefits
are expected to be claimed, the role of the entities or individuals mentioned in lines 7a or 8a (if any) and the role of the financial instruments
mentioned in line 9 (if any). Explain how the Internal Revenue Code sections listed in line 12 are applied and how they allow the taxpayer to
obtain the desired tax treatment. Also, include a description of any tax result protection with respect to the transaction.
Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and complete.
Please
Sign
Title
Signature of Material Advisor
Date
Here
Print name
8918
Form
(Rev. 12-2011)
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