8918 Material Advisor Disclosure Statement

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Material Advisor Disclosure Statement

OMB No. 1545-0865

.. See separate instructions.

Note: The reportable transacti~~e!will

FOR IRS USE ONLY

be sent to the material advisor's address~-,

Material Advisor's Name (see instructions)

Telephone number

Number, street, and room or suite no.
City or town, state, and ZIP code

~
A

Contact person name (last name, first name, middle initial)

Telephone number

..'-f:

B
C
If "Yes," go to Line 1. If "No,"
Re ortable Transaction Number ...

1 Name of reportable transaction (see instructions)
instructions).

0
b0

8

Listed

0
d0
c

Confidential

Contractual protection

Loss

f

0

Brief asset holding period

3 If you checked box 2a or 2e, enter the published guidance number for the listed transaction or transaction of interest"

-

4 Enter the date the Material Advisor became a material advisor with respect to the reportable transaction (see instructions) ..
5 If
Name
own)
Address (Number, street, and room or suite no.)
City or town, state, and ZIP code

6a Provide a brief description of the type of material aid, assistance, or advice you provided (see instructions).

b

ex en
transaction

and

l,gescribethe roleof anyotherentity(ies)
or individual(s)
who alsoprovidedAriaterial
aid, assistance,
or adviceto this
inclu~ach

entity's

and

individual's

complete

name,

identifying

number

(if kncMn),

and

J 01'

address.

~W
v

~e.,
ret4lW\
7a To obtain the intended tax benefits generated by the transaction:
Is a related

entity(ies)

or ind/vidual(s)

needed?

Is a foreign entity(ies)or individual(s)needed?
Is a tax-exempt entity(ies)needed?

0

Yes

0

No

0
0

Yes

0
0

No

Yes

-\-D
[,"Il'>W'

No

t~

b If you answered "Yes" to any of the above questions, describe the role of each individual or entity. Also identify the individual's or
entity's country of existence if a particular country is required to obtain the intended tax benefits.

8a To obtain the intended tax benefits generated by the transaction, is income or gain from the transaction allocated directly or indirectly to an
individual(s)or entity(ies)that has a net operating loss and/or unused loss or credits?
0 Yes 0 No
b If "Yes," describe the role of each individual or entity in the transaction.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 39533A

Form 8918

(ReV,!-2007)

10

Identify the types of financial instruments used in this transaction (see instructions).

10

Estimated
Tax Benefits-Identify
the type of tax benefit generated by the
Check all boxes that apply (see instructions).

0

0
0

0

Deductions
Capital loss
Ordinary loss

0
0

Exclusionsfrom gross income
Nonrecognitionof gain
Adjustments to basis

0

Tax credits

0
0

Deferral

to claim in each year.

0

Other

which

suchtax
0

the taxpayer.

0
12

Enter

13

Describe the reportable transaction for which you
material aid, assistance or advice, including but not limited to the following:
the nature of the expected tax treatment and expected tax benefits generated by the transaction for all affected years, the years the tax
benefits are expected to be claimed, the role of the entities or individuals mentioned in lines 7a or 8a (if any) and the role of the financial
instruments mentioned in line 9 (if any). Explain how the Internal Revenue Code sections listed in line 12 are applied and how they allow
the taxpayer to obtain the desired tax treatment. Also, include a description of any tax result protection with respect to the transaction.

(Attach additional sheets if necessary.)

Under penalties of perjury, I declare that I have examined this retum, and to the best of my knowledge and belief, it is true, correct, and complete.
Declaration of pre parer (other than Material Advisor) is based on all information of which preparer has any knowledge.

Please
Sign
Here

~

Signature

~

Prlntname

of Material

Date

Advisor

Title

~

Pre~er's
~rm

8918 (Rev.
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