Form 3520 - Annual Return To Report Transactions With Foreign Trusts And Receipt Of Certain Foreign Gifts - 2017 Page 2

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2
Form 3520 (2017)
Page
Part I
Transfers by U.S. Persons to a Foreign Trust During the Current Tax Year (see instructions)
5a
b Address
Name of trust creator
c Identification number (if any)
6a
Country code of country where trust was created
b Country code of country whose law governs the trust
c Date trust was created
Will any person (other than the U.S. transferor or the foreign trust) be treated as the owner of the transferred assets after
7 a
the transfer?
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Yes
No
(i)
(v)
b
(ii)
(iii)
(iv)
Name of other foreign
Relevant Code
Address
Country of residence
Identification number, if any
trust owners, if any
section
8
Was the transfer a completed gift or bequest? If “Yes,” see instructions .
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Yes
No
9a
Yes
No
Now or at any time in the future, can any part of the income or corpus of the trust benefit any U.S. beneficiary? .
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b
If “No,” could the trust be revised or amended to benefit a U.S. beneficiary?.
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Yes
No
10
Will you continue to be treated as the owner of the transferred asset(s) after the transfer? .
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Yes
No
Schedule A—Obligations of a Related Trust (see instructions)
11 a
During the current tax year, did you transfer property (including cash) to a related foreign trust in exchange for an
obligation of the trust or an obligation of a person related to the trust (see instructions)? .
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Yes
No
If “Yes,” complete the rest of Schedule A, as applicable. If “No,” go to Schedule B.
b
Yes
No
Were any of the obligations you received (with respect to a transfer described in line 11a above) qualified obligations? .
If “Yes,” complete the rest of Schedule A with respect to each qualified obligation.
If “No,” go to Schedule B and, when completing columns (a) through (i) of line 13 with respect to each nonqualified
obligation, enter “-0-” in column (h).
(i)
(ii)
(iii)
(iv)
Date of transfer giving rise to obligation
Maximum term
Yield to maturity
FMV of obligation
12
With respect to each qualified obligation you reported on line 11b: Do you agree to extend the period of assessment of
any income or transfer tax attributable to the transfer, and any consequential income tax changes for each year that the
obligation is outstanding, to a date 3 years after the maturity date of the obligation?
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Yes
No
Note: You have the right to refuse to extend the period of limitations or limit this extension to a mutually agreed-upon
issue(s) or mutually agreed-upon period of time. Generally, if you refuse to extend the period of limitations with respect
to each qualified obligation you reported on line 11b, then such obligation is not a qualified obligation and you cannot
check “Yes” to the question on line 11b.
Schedule B—Gratuitous Transfers (see instructions)
13
During the current tax year, did you make any transfers (directly or indirectly) to the trust and receive less than FMV,
or no consideration at all, for the property transferred? .
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Yes
No
If “Yes,” complete columns (a) through (i) below and the rest of Schedule B, as applicable.
If “No,” go to Schedule C.
(f)
(d)
(e)
(g)
(b)
Excess, if any,
(i)
(a)
(c)
U.S. adjusted
Gain recognized
Description
(h)
Description
of column (c)
Excess of
Date of
FMV of property
basis of
at time of
of property
FMV of property
of property
over the sum of
column (c) over
transfer
transferred
property
transfer,
received,
received
transferred
columns
column (h)
transferred
if any
if any
(d) and (e)
Totals
$
$
▶
14
You are required to attach a copy of each sale or loan document entered into in connection with a transfer reported on line 13. If these
documents have been attached to a Form 3520 filed within the previous 3 years, attach only relevant updates.
Attached
Year
Yes
No
Previously
Attached
Are you attaching a copy of:
a
Sale document?
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b
Loan document? .
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c
Subsequent variances to original sale or loan documents? .
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3520
Form
(2017)

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