California Form 3726 - Deferred Intercompany Stock Account (Disa) And Capital Gains Information - 2012

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Deferred Intercompany Stock Account (DISA)

TAXABLE YEAR

CALIFORNIA FORM

and Capital Gains Information

2012

3726

Attach to Form 100 or Form 100W.

Corporation name (distribution recipient)

California corporation number

Part I

Prior Years DISA Information (Cal. Code Regs., tit. 18 section 25106.5-1(b)(8)). Attach additional sheets if necessary.

Fill out Part l completely to satisfy the annual disclosure requirements. (Complete a separate form FTB 3726 for each corporation that received the distribution).

(a)

(b)

(c)

(d)

(e)

Name of distributor

Year of deferral

Ownership percentage at time of distribution

Current ownership percentage

DISA balance

Part II Current Year DISA Information. Attach additional sheets if necessary.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

Name of distributor

Percentage

Distribution

Amount from

Deferred capital gains

amount

column (c) paid out

column (c)

(current year DISA

ownership

of current year E&P

of accumulated E&P

reducing basis of the

balance) (column (c)

of dividend

distributors stock

less the sum of columns

distributor

(d), (e), & (f))

Part III DISA Capital Gains Recognized This Taxable Year (Cal. Code Regs., tit. 18 section 25106.5-1(f)(1)(B)). Attach additional sheets if necessary.

Check column (g), Box A if the gain is a short-term capital gain

Check column (g), Box B if partial sale of stock

(a)

(b)

(c)

(d)

(e)

(f)

(g)

Name of distributor

Year of deferral

Type of

DISA balance

Recognition ratio

Amount of

triggering event

capital gain recognized

(column (d) x (e))

Box A

Box B

2 Short-term DISA capital gains. Add the amounts in Line 1, column (f) where column (g), Box A is checked. Enter here and on Forms 100 or 100W, Side 5,

Schedule D, Part 1, line 1, column (f). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Long-term DISA capital gains. Add the amounts in Line 1, column (f) where column (g), Box A is not checked. Enter here and on Forms 100 or 100W, Side 5,

Schedule D, Part II, line 5, column (f). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .