3520-A Annual Information Return of Foreign Trust With a U.S. O

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Date

I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 3520-A, PAGE 1 of 4
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203mm (8") x 559mm (22"), TOP FOLD TO: 203mm (8") x 279mm(11")
PERFORATE: HORIZONTALLY ON 8" FOLD

Date

Revised proofs
requested

Annual Information Return of Foreign
Trust With a U.S. Owner

3520-A

OMB No. 1545-0160

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2010

(Under section 6048(b))

Department of the Treasury
Internal Revenue Service

Signature

O.K. to print

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

Form

Action

©

See separate instructions.

Note: All information must be in English. Show all amounts in U.S. dollars.
For calendar year 2010, or tax year beginning

Check appropriate boxes.

Part I

, 2010, ending

Initial return

, 20

Final return

.

Amended return

General Information (see instructions)

1a Name of foreign trust

b

Employer identification number

g

Country

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town

2

e State or province

f ZIP or postal code

Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust
information?

Yes

No

If “Yes,” skip lines 2a through 2e and go to line 3.

If “No,” you are required to attach a copy of all trust documents as indicated below. If these documents have been attached to a Form
3520-A filed within the previous 3 years, attach only relevant updates.
Attached
Year
Have you attached a copy of:
Yes
No
Previously Attached
a Summary of all written and oral agreements and understandings relating to the trust?
b The trust instrument?
c Memoranda or letters of wishes?
d Subsequent variances to original trust documents?
e Other trust documents?
3a Name of U.S. agent

b

Identification number

g

Country

b

Identification number, if any

g

Country

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town

e State or province

f ZIP or postal code

4a Name of trustee

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town

e State or province

f ZIP or postal code

5

Did the trust transfer any property (including cash) to another person (see instructions for definition) during the tax
year? If “Yes,” attach statement (see instructions).

6

Enter the number of Foreign Grantor Trust Owner Statements (page 3) included with this Form 3520-A

Sign
Here

No

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of
my knowledge and belief, it is true, correct, and complete.

©

©

Trustee’s Signature
Print/Type preparer’s name

Paid
Preparer
Use Only

Yes

©

Firm’s name

Preparer’s signature

©

Title
Date

©

Firm’s address

Check
if
self-employed
Firm’s EIN

©

For Paperwork Reduction Act Notice, see instructions.

Date
PTIN

©

Phone no.
Cat. No. 19595G

Form

3520-A

(2010)

2
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 3520-A, PAGE 2 of 4
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203mm (8") x 559mm (22"), TOP FOLD TO: 203mm (8") x 279mm (11")
PERFORATE: HORIZONTALLY ON 8" FOLD

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

Form 3520-A (2010)

Expenses

Income

Part II

Page

2

Foreign Trust Income Statement
Enter totals from books and records of foreign trust (see instructions).

1
2
3
4
5

Interest

a
b
6
7
8

Net short-term capital gain (loss)

Dividends
Gross rents and royalties

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Income (loss) from partnerships and fiduciaries
Capital gains:

9
10a
b
11
12
13
14
15
16

Net long-term capital gain (loss)
Ordinary gains (losses)
Other income (attach schedule)
Total income (add lines 1 through 7)
Interest expense
Foreign taxes (attach schedule)
State and local taxes
Amortization and depreciation (depletion)
Trustee and advisor fees
Charitable contributions
Other expenses (attach schedule)
Total expenses (add lines 9 through 14)

Net income (loss) (subtract line 15 from line 8)

17a Enter the fair market value (FMV) of total distributions from the trust to all persons, whether U.S. or foreign
b Distributions to U.S. owners:
(i) Name of owner

©

(ii) Identification number

(iii) Date of distribution

(iv) FMV

(ii) Identification number

(iii) Date of distribution

(iv) FMV

c Distributions to U.S. beneficiaries:
(i) Name of beneficiary

Part III Foreign Trust Balance Sheet
Assets
1
2
3
4
5
6
7
8a
b
9
10
11

Cash

12
13
14
15
16

Accounts payable

17
18
19
20
21

Contributions to trust corpus

Beginning of Tax Year
(a)

(b)

End of Tax Year
(c)

(d)

Accounts receivable
Mortgages and notes receivable
Inventories
Government obligations
Other marketable securities
Other nonmarketable securities
Depreciable (depletable) assets
Less: accumulated depreciation (depletion)
Real property
Other assets (attach schedule)
Total assets

Liabilities
Contributions, gifts, grants, etc., payable
Mortgages and notes payable
Other liabilities (attach schedule)
Total liabilities

Net Worth
Accumulated trust income
Other (attach schedule)
Total net worth (add lines 17 through 19)
Total liabilities and net worth (add lines 16 and 20)
Form

3520-A

(2010)

2
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 3520-A, PAGE 3 of 4
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203mm (8") x 559mm (22"), TOP FOLD TO: 203mm (8") x 279mm (11")
PERFORATE: HORIZONTALLY ON 8" FOLD

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

Form 3520-A (2010)

Page

3

2010 Foreign Grantor Trust Owner Statement (see instructions)

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Important: Trustee must prepare a separate statement for each U.S. owner and include a copy of each statement with Form 3520-A. Trustee is also required
to send to each U.S. owner a copy of the owner’s statement. U.S. owner must attach a copy of its statement to Form 3520.
1a Name of foreign trust

b Employer identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

e State or province

f ZIP or postal code

g Country

Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust information?
Yes
If “Yes,” complete lines 3a through 3g.
3a Name of U.S. agent
b Identification number
2

No

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

e State or province

4a Name of trustee

f ZIP or postal code

g Country

b Identification number (if any)

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town
5

e State or province

f ZIP or postal code

The tax year of the owner of the foreign trust to which this statement relates

g Country

©

6a Name of U.S. owner

b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

e State or province

h Service Center where U.S. owner files its income tax returns

f ZIP or postal code

g Country

©

7

Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or
portion of the foreign trust) is treated for U.S. tax principles as owned by the U.S. person.

8

If the trust did not appoint a U.S. agent, list the trust documents attached to Form 3520-A (see instructions).

9

Gross value of the portion of the trust treated as owned by the U.S. owner

$

2010 Statement of Foreign Trust Income Attributable to U.S. Owner (see instructions)
Report each item on the proper form or schedule of your tax return.

Expenses

Income

1a Taxable interest
b Tax-exempt interest ©
2a Total ordinary dividends
b Qualified dividends ©
3

Gross rents and royalties

4

Income from partnerships and fiduciaries

5
6
7

Capital gains (losses)
Ordinary gains (losses)
Other income (attach schedule)

8

Interest expense

9a Foreign taxes (attach schedule)
b State and local taxes
10

Amortization and depreciation (depletion)

11
12
13

Trustee and advisor fees
Charitable contributions
Other expenses (attach schedule)

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge
and belief, it is true, correct, and complete.
Trustee Signature

©

Title

©

Date
Form

©

3520-A

(2010)

2
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 3520-A, PAGE 4 of 4
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203mm (8") x 559mm (22"), TOP FOLD TO: 203mm (8") x 279mm (11")
PERFORATE: HORIZONTALLY ON 8" FOLD

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

Form 3520-A (2010)

Page

4

2010 Foreign Grantor Trust Beneficiary Statement

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Important: Trustee must prepare a separate statement for each U.S. beneficiary that received a distribution from the trust during the tax year and
include a copy of each statement with Form 3520-A. Trustee is also required to send to each such beneficiary a copy of the
beneficiary’s statement. U.S. beneficiary must attach a copy of its statement to Form 3520.
1a Name of foreign trust

b Employer identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

2

e State or province

f ZIP or postal code

g Country

Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust
information?
If “Yes,” complete lines 3a through 3g.

If “No,” do you agree that either the IRS or the U.S. beneficiary can inspect and copy the trust’s permanent books
of account, records, and such other documents that are necessary to establish that the trust should be treated for
U.S. tax purposes as owned by another person?
3a Name of U.S. agent

Yes

No

Yes

No

b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

e State or province

f ZIP or postal code

4a Name of trustee

g Country

b Identification number (if any)

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town

e State or province

f ZIP or postal code

5 The first and last day of the tax year of the foreign trust to which Form 3520-A applies
6a Name of U.S. beneficiary

g Country

©

b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town
7

e State or province

f ZIP or postal code

g Country

Description of property (including cash) distributed, or treated as distributed, to the U.S. person during the tax year. (See the instructions
for Part III of Form 3520 for U.S. tax treatment of these amounts.)
(a) Description of property

(b) FMV

8

Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or
portion of the foreign trust) is treated for U.S. tax principles as owned by another person.

9

Owner of the foreign trust is (check one):
Individual

Partnership

Corporation

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge
and belief, it is true, correct, and complete.

Trustee Signature

©

Title

©

Date
Form

Printed on Recycled Paper

©

3520-A

(2010)