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Form 1066 (2012)
Page
Designation of Tax Matters Person
Enter below the residual interest holder designated as the tax matters person (TMP) for the calendar year of this return.
Name of
Identifying
designated TMP
number of TMP
Address of
designated TMP
Additional Information (see instructions)
E
Yes No
What type of entity is this REMIC? Check box
Corporation
Partnership
Trust
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Segregated Pool of Assets
If you checked “Segregated Pool of Assets,” enter the name and type of entity that owns the assets:
Name
Type
Number of residual interest holders in this REMIC
F
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G
Check this box if this REMIC is subject to the consolidated entity-level audit procedures of sections 6221
through 6231
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H
At any time during calendar year 2012, did the REMIC have a financial interest in or signature or other authority
over any foreign financial account, including bank, securities, or other types of financial accounts in a foreign
country? .
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If “Yes,” the REMIC may have to file Form TD F 90-22.1. See instructions.
If “Yes,” enter name of foreign country
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I
During the tax year, did the REMIC receive a distribution from, or was it the grantor of, or transferor to, a foreign
trust? If “Yes,” see instructions for other forms the REMIC may have to file .
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Enter the amount of tax-exempt interest accrued during the year
J
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K
Check this box if the REMIC had more than one class of regular interests
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If so, attach a statement identifying the classes and principal amounts outstanding for each at the end of the year.
L
Enter the sum of the daily accruals determined under section 860E(c) for the calendar year
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Balance Sheets per Books
(a) Beginning of year
(b) End of year
Schedule L
Assets
1
Permitted investments (see instructions):
a Cash flow investments
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b Qualified reserve assets .
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c Foreclosure property .
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Qualified mortgages
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Other assets (attach statement)
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Total assets .
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Liabilities and Capital
5
Current liabilities (attach statement) .
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Other liabilities (attach statement) .
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Regular interests in REMIC .
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Residual interest holders’ capital accounts .
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Total liabilities and capital
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Schedule M
Reconciliation of Residual Interest Holders’ Capital Accounts (Show reconciliation of each
residual interest holder’s capital account quarterly on Schedule Q (Form 1066), Item F.)
(a) Residual interest
(g) Residual interest
(b) Capital
(c) Taxable income
holders’ capital
(d) Nontaxable
(e) Unallowable
(f) Withdrawals and
holders’ capital accounts
contributed during
(or net loss) from
accounts at
income
deductions
distributions
at end of year (combine
year
Section I, line 15
beginning of year
cols. (a) through (f))
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1066
Form
(2012)