Form 926 Form 926 Return by a U.S. Transferor of Property to a Foreign Cor

8
TLS, have you
transmitted all R
text files for this
cycle update?

I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 926, PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216 mm (8 1⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD

Date

Action

Department of the Treasury
Internal Revenue Service

Part I

Revised proofs
requested

Return by a U.S. Transferor of Property
to a Foreign Corporation

Form
(Rev. December 2008)
©

Signature

O.K. to print

PRINTS: HEAD TO HEAD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

926

Date

OMB No. 1545-0026

f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
1

Attachment
Sequence No.

Attach to your income tax return for the year of the transfer or distribution.

128

U.S. Transferor Information (see instructions)

Name of transferor

Identifying number (see instructions)

1

If the transferor was a corporation, complete questions 1a through 1d.
a If the transfer was a section 361(a) or (b) transfer, was the transferor controlled (under section 368(c)) by
5 or fewer domestic corporations?
b Did the transferor remain in existence after the transfer?
If not, list the controlling shareholder(s) and their identifying number(s):
Controlling shareholder

Yes
Yes

No
No

Yes

No

Yes

No

Identifying number

c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent
corporation?
If not, list the name and employer identification number (EIN) of the parent corporation:
Name of parent corporation

EIN of parent corporation

d Have basis adjustments under section 367(a)(5) been made?
2

If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367),
complete questions 2a through 2d.
a List the name and EIN of the transferor’s partnership:
Name of partnership

EIN of partnership

b Did the partner pick up its pro rata share of gain on the transfer of partnership assets?
c Is the partner disposing of its entire interest in the partnership?
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market?

Part II

Yes
Yes

No
No

Yes

No

Transferee Foreign Corporation Information (see instructions)

3

Name of transferee (foreign corporation)

5

Address (including country)

6

Country code of country of incorporation or organization (see instructions)

7

Foreign law characterization (see instructions)

8

Is the transferee foreign corporation a controlled foreign corporation?

For Paperwork Reduction Act Notice, see separate instructions.

4 Identifying number, if any

Yes
Cat. No. 16982D

Form

926

No

(Rev. 12-2008)

8
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 926, PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD

PRINTS: HEAD TO HEAD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 926 (Rev. 12-2008)

Part III

Page

2

Information Regarding Transfer of Property (see instructions)

Type of
property

Cash
Stock and
securities

Installment
obligations,
account
receivables or
similar property
Foreign currency
or other property
denominated in
foreign currency

Inventory

(a)
Date of
transfer

f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
1

(b)
Description of
property

(c)
Fair market value on
date of transfer

(d)
Cost or other
basis

(e)
Gain recognized on
transfer

Assets subject to
depreciation
recapture (see
Temp. Regs. sec.
1.367(a)-4T(b))
Tangible property
used in trade or
business not listed
under another
category

Intangible
property
Property to be
leased (as
described in
Temp. Regs. sec.
1.367(a)-4T(c))
Property to be
sold (as
described in
Temp. Regs. sec.
1.367(a)-4T(d))
Transfers of oil and
gas working interests
(as described in
Temp. Regs. sec.
1.367(a)-4T(e))

Other property

Supplemental Information Required To Be Reported (see instructions):

Form

926

(Rev. 12-2008)

8
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 926, PAGE 3 of 4 (page 4 is blank)
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD

PRINTS: HEAD TO HEAD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 926 (Rev. 12-2008)

Part IV

Page

3

Additional Information Regarding Transfer of Property (see instructions)

f
o
s
a
8
t
0
f
0
a
2
r
/
D /30
0
1

9 Enter the transferor’s interest in the foreign transferee corporation before and after the transfer:
(a) Before

% (b) After

%

©

10

Type of nonrecognition transaction (see instructions)

11

Indicate whether any transfer reported in Part III is subject to any of the following:
Gain recognition under section 904(f)(3)
Gain recognition under section 904(f)(5)(F)
Recapture under section 1503(d)
Exchange gain under section 987

Yes
Yes
Yes
Yes

No
No
No
No

12

Did this transfer result from a change in the classification of the transferee to that of a foreign corporation?

Yes

No

13

Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
Tainted property
Depreciation recapture
Branch loss recapture
Any other income recognition provision contained in the above-referenced regulations

Yes
Yes
Yes
Yes

No
No
No
No

Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)?

Yes

No

15a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations
section 1.367(a)-1T(d)(5)(iii)?

Yes

No

Yes

No

Yes

No

a
b
c
d

a
b
c
d
14

b If the answer to line 15a is “Yes,” enter the amount of foreign goodwill or going concern value
transferred © $
16

Was cash the only property transferred?

17a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the
transaction?
b If “Yes,” describe the nature of the rights to the intangible property that was transferred as a result of the
transaction:

Form

Printed on recycled paper

926

(Rev. 12-2008)