Form 5471 - Schedule O - Organization Or Reorganization Of Foreign Corporation, And Acquisitions And Dispositions Of Its Stock

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Organization or Reorganization of Foreign
SCHEDULE O
Corporation, and Acquisitions and
(Form 5471)
Dispositions of its Stock
OMB No. 1545-0704
(Rev. December 2012)
Information about Schedule O (Form 5471) and its instructions is at
Department of the Treasury
Attach to Form 5471.
▶
Internal Revenue Service
Name of person filing Form 5471
Identifying number
Name of foreign corporation
EIN (if any)
Reference ID number (see instructions)
Important: Complete a separate Schedule O for each foreign corporation for which information must be reported.
Part I
To Be Completed by U.S. Officers and Directors
(a)
(c)
(d)
(e)
(b)
Name of shareholder for whom
Identifying number
Date of original
Date of additional
Address of shareholder
acquisition information is reported
of shareholder
10% acquisition
10% acquisition
Part II
To Be Completed by U.S. Shareholders
Note: If this return is required because one or more shareholders became U.S. persons, attach a list showing the names
of such persons and the date each became a U.S. person.
Section A—General Shareholder Information
(c)
(b)
(a)
Date (if any) shareholder
For shareholder’s latest U.S. income tax return filed, indicate:
Name, address, and identifying number of
last filed information
(1)
(3)
(2)
shareholder(s) filing this schedule
return under section 6046
Type of return
Internal Revenue Service Center
Date return filed
for the foreign corporation
(enter form number)
where filed
Section B—U.S. Persons Who Are Officers or Directors of the Foreign Corporation
(d)
Check appropriate
(a)
(b)
(c)
box(es)
Name of U.S. officer or director
Address
Social security number
Officer
Director
Section C—Acquisition of Stock
(e)
(b)
(c)
(d)
Number of shares acquired
(a)
Class of stock
Date of
Method of
Name of shareholder(s) filing this schedule
(1)
(2)
(3)
acquired
acquisition
acquisition
Directly
Indirectly
Constructively
For Paperwork Reduction Act Notice, see the Instructions for Form 5471.
Cat. No. 61200O
Schedule O (Form 5471) (Rev. 12-2012)

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