Form 8621 - Information Return By A Shareholder Of A Passive Foreign Investment Company Or Qualified Electing Fund Page 2

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Form 8621 (Rev. 12-2011)
Page
Part III
Gain or (Loss) From Mark-to-Market Election (See instructions.)
5a
5a
Enter the fair market value of your PFIC stock at the end of the tax year .
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b
Enter your adjusted basis in the stock at the end of the tax year
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5b
c
Subtract line 5b from line 5a. If a gain, do not complete lines 6 and 7. Include this amount as ordinary income
5c
on your tax return. If a loss, go to line 6
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6
Enter any unreversed inclusions (as defined in section 1296(d))
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6
7
Enter the loss from line 5c, but only to the extent of unreversed inclusions on line 6. Include this amount as an
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ordinary loss on your tax return .
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8
If you sold or otherwise disposed of any section 1296 stock (see instructions) during the tax year:
a
Enter the fair market value of the stock on the date of sale or disposition
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8a
b
Enter the adjusted basis of the stock on the date of sale or disposition
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8b
c
Subtract line 8b from line 8a. If a gain, do not complete line 9. Include this amount as ordinary income on your
tax return. If a loss, go to line 9 .
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8c
9a
Enter any unreversed inclusions (as defined in section 1296(d))
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9a
b
Enter the loss from line 8c, but only to the extent of unreversed inclusions on line 9a. Include this amount as an
ordinary loss on your tax return. If the loss on line 8c exceeds unreversed inclusions on line 9a, complete line 9c
9b
c
Enter the amount by which the loss on line 8c exceeds unreversed inclusions on line 9a. Include this amount on
your tax return according to the rules generally applicable for losses provided elsewhere in the Code and
regulations .
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9c
Note. See instructions in case of multiple dispositions.
Part IV
Distributions From and Dispositions of Stock of a Section 1291 Fund (See instructions.)
Complete a separate Part IV for each excess distribution (see instructions).
10 a
Enter your total distributions from the section 1291 fund during the current tax year with respect to the
applicable stock. If the holding period of the stock began in the current tax year, see instructions
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10a
b
Enter the total distributions (reduced by the portions of such distributions that were excess distributions but
not included in income under section 1291(a)(1)(B)) made by the fund with respect to the applicable stock for
each of the 3 years preceding the current tax year (or if shorter, the portion of the shareholder’s holding period
10b
before the current tax year) .
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c
Divide line 10b by 3. (See instructions if the number of preceding tax years is less than 3.)
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10c
d
Multiply line 10c by 125% (1.25)
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10d
e
Subtract line 10d from line 10a. This amount, if more than zero, is the excess distribution with respect to the
applicable stock. If zero or less and you did not dispose of stock during the tax year, do not complete the
rest of Part IV. See instructions if you received more than one distribution during the current tax year. Also,
see instructions for rules for reporting a nonexcess distribution on your income tax return
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10e
f
Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund. If a gain,
complete line 11. If a loss, show it in brackets and do not complete line 11.
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10f
11 a
Attach a statement for each distribution and disposition. Show your holding period for each share of stock or
block of shares held. Allocate the excess distribution to each day in your holding period. Add all amounts that
are allocated to days in each tax year.
b
Enter the total of the amounts determined in line 11a that are allocable to the current tax year and tax years before the
11b
foreign corporation became a PFIC (pre-PFIC tax years). Enter these amounts on your income tax return as other income
c
Enter the aggregate increases in tax (before credits) for each tax year in your holding period (other than the
current tax year and pre-PFIC years). (See instructions.)
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11c
d
Foreign tax credit. (See instructions.) .
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11d
e
11e
Subtract line 11d from line 11c. Enter this amount on your income tax return as “additional tax.” (See instructions.)
f
Determine interest on each net increase in tax determined on line 11e using the rates and methods of section
6621. Enter the aggregate amount of interest here. (See instructions.)
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11f
8621
Form
(Rev. 12-2011)

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