Schedule G (Form 1120) - Information On Certain Persons Owning The Corporation'S Voting Stock

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Information on Certain Persons Owning the
SCHEDULE G
(Form 1120)
Corporation’s Voting Stock
OMB No. 1545-0123
(Rev. December 2011)
Attach to Form 1120.
▶
Department of the Treasury
See instructions on page 2.
Internal Revenue Service
▶
Name
Employer identification number (EIN)
Part I
Certain Entities Owning the Corporation’s Voting Stock. (Form 1120, Schedule K, Question 4a). Complete
columns (i) through (v) below for any foreign or domestic corporation, partnership (including any entity treated
as a partnership), trust, or tax-exempt organization that owns directly 20% or more, or owns, directly or
indirectly, 50% or more of the total voting power of all classes of the corporation’s stock entitled to vote (see
instructions).
(ii) Employer Identification
(i) Name of Entity
(iii) Type of Entity
(iv) Country of Organization
(v) Percentage Owned in Voting Stock
Number (if any)
Part II
Certain Individuals and Estates Owning the Corporation’s Voting Stock. (Form 1120, Schedule K,
Question 4b). Complete columns (i) through (iv) below for any individual or estate that owns directly 20% or
more, or owns, directly or indirectly, 50% or more of the total voting power of all classes of the corporation’s
stock entitled to vote (see instructions).
(iii) Country of
(ii) Identifying Number
(iv) Percentage Owned
(i) Name of Individual or Estate
Citizenship (see
(if any)
in Voting Stock
instructions)
For Paperwork Reduction Act Notice,
Cat. No. 52684S
Schedule G (Form 1120) (Rev. 12-2011)
see the Instructions for Form 1120.

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