Form 5713 - International Boycott Report
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45713
OMB No. 1545-0216
International Boycott Report
Attachment
Form
Sequence No. 123
,
For tax year beginning
, 20
(Rev. December 2010)
Paper filers must file in
.
and ending
, 20
Department of the Treasury
duplicate (see When and Where
Controlled groups, see instructions.
Internal Revenue Service
to File in the instructions)
▶
Name
Identifying number
Number, street, and room or suite no. If a P.O. box, see instructions.
City or town, state, and ZIP code
Address of service center where your tax return is filed
Type of filer (check one):
Individual
Partnership
Corporation
Trust
Estate
Other
1
Individuals—Enter adjusted gross income from your tax return (see instructions)
2
Partnerships and corporations:
a Partnerships—Enter each partner’s name and identifying number.
b Corporations—Enter the name and employer identification number of each member of the controlled group (as defined in
section 993(a)(3)). Do not list members included in the consolidated return; instead, attach a copy of Form 851. List all other
members of the controlled group not included in the consolidated return.
If you list any corporations below or if you attach Form 851, you must designate a common tax year. Enter on line 4b
the name and employer identification number of the corporation whose tax year is designated.
Name
Identifying number
If more space is needed, attach additional sheets and check this box .
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Code
Description
c Enter principal business activity code and description (see instructions)
d
IC-DISCs—Enter principal product or service code and description (see instructions)
3
Partnerships—Each partnership filing Form 5713 must give the following information:
a Partnership’s total assets (see instructions) .
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b Partnership’s ordinary income (see instructions) .
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4
Corporations—Each corporation filing Form 5713 must give the following information:
a
Type of form filed (Form 1120, 1120-FSC, 1120-IC-DISC, 1120-L, 1120-PC, etc.)
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b Common tax year election (see instructions)
(1) Name of corporation
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(2) Employer identification number
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(3)
Common tax year beginning
, 20
, and ending
, 20
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c Corporations filing this form enter:
(1) Total assets (see instructions) .
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(2) Taxable income before net operating loss and special deductions (see instructions) .
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5
Estates or trusts—Enter total income (Form 1041, page 1)
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6
Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions):
a Foreign tax credit .
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b Deferral of earnings of controlled foreign corporations .
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c Deferral of IC-DISC income .
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d FSC exempt foreign trade income .
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e Foreign trade income qualifying for the extraterritorial income exclusion
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Please
Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Sign
Here
Signature
Date
Title
5713
For Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 12-2010)
Cat. No. 12030E
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