Form 5452 - Corporate Report Of Nondividend Distributions 1994

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5452
Corporate Report of Nondividend Distributions
Form
(Rev. December 1994)
OMB No. 1545-0205
For calendar year ending December 31, 19
Department of the Treasury
Attach to the corporation’s income tax return.
Internal Revenue Service
Name
Employer identification number
A
Has the corporation filed a Form 5452 for a prior calendar year?
Yes
No
If “Yes,” state which year(s)
B
Are any of the distributions part of a partial or complete liquidation?
Yes
No
If “Yes,” discuss in a separate statement.
D
Shareholders at Date of Last Dividend Payment
C
Earnings and Profits
Number of individuals
Accumulated earnings and profits
Number of partnerships
(since February 28, 1913) at the
beginning of the tax year
$
Number of corporations and other
shareholders
Note: If there are 12 or fewer shareholders, attach copies of the
Actual earnings and profits for the
Forms 1099-DIV (or the information from that form) that the
current tax year
$
shareholders received.
E Corporate Distributions (See instructions.)
Amount Paid During Calendar Year From Earnings & Profits
Amount Paid During
Total Amount Paid
Calendar Year From
Amount
Since February 28, 1913
Percent
Percent
(Common (C),
Date Paid
Per
Other Than Earnings
Taxable
Nontaxable
Preferred (P),
From the
& Profits Since
Share
Accumulated
Total
Other (O))
Current Year
February 28, 1913
%
$
%
$
$
$
$
$
Totals
$
$
$
$
$
5452
For Paperwork Reduction Act Notice, see the instructions on page 2.
Cat. No. 11881T
Form
(Rev. 12-94)

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