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pdfForm
8275-R
(Rev. February 2002)
Regulation Disclosure Statement
Department of the Treasury
Internal Revenue Service
䊳
Attachment
Sequence No.
Attach to your tax return.
Name(s) shown on return
Part I
OMB No. 1545-0889
Use this form only to disclose items or positions that are contrary to Treasury regulations.
For other disclosures, use Form 8275, Disclosure Statement. See separate instructions.
92A
Identifying number shown on return
General Information (See instructions.)
(a)
Regulation Section
(b)
Item or Group
of Items
(c)
Detailed Description
of Items
(d)
Form or
Schedule
(e)
Line
No.
(f)
Amount
1
2
3
Part II
Detailed Explanation (See instructions.)
1
2
3
Part III
Information About Pass-Through Entity. To be completed by partners, shareholders, beneficiaries, or
residual interest holders.
Complete this part only if you are making adequate disclosure for a pass-through item.
Note: A pass-through entity is a partnership, S corporation, estate, trust, regulated investment company (RIC), real estate investment
trust (REIT), or real estate mortgage investment conduit (REMIC).
1 Name, address, and ZIP code of pass-through entity
2 Identifying number of pass-through entity
3 Tax year of pass-through entity
/
/
to
/
/
4 Internal Revenue Service Center where the pass-through entity filed
its return
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 14594X
Form
8275-R
(Rev. 2-2002)
Form 8275-R (Rev. 2-2002)
Part IV
Explanations (continued from Parts I and/or II)
Page
2
File Type | application/pdf |
File Title | Form 8275-R (Rev. 2-2002) |
Subject | Regulation Disclosure Statement |
Author | T:FP |
File Modified | 2005-10-24 |
File Created | 2002-04-02 |