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

Form

3520-A

Department of the Treasury
Internal Revenue Service

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

OMB No. 1545-0160

2015

(Under section 6048(b))

▶

Information about Form 3520-A and its separate instructions is at www.irs.gov/form3520a.

Note: All information must be in English. Show all amounts in U.S. dollars.
For calendar year 2015, or tax year beginning

Check appropriate boxes.

, 2015, ending

Initial return

Final return

, 20

Check if any excepted specified foreign financial assets are reported on this form (see instructions) .

Part I
1a

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Amended return
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General Information (see instructions)

Name of foreign trust

b(1) Employer identification number

c

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

b(2) Reference ID number (see instructions)

d

City or town

2

e

f

State or province

ZIP or foreign postal code

g

Country

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

a
b
c
d
e
3a

The trust instrument? . . . . . . . . .
Memoranda or letters of wishes? . . . . .
Subsequent variances to original trust documents?
Other trust documents? . . . . . . . .

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

d

City or town

e

f

State or province

ZIP or postal code

Name of trustee

c

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

d

City or town

e

f

State or province

ZIP or postal code

b

Identification number

g

Country

b

Identification number, if any

g

Country

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 .

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Yes

No

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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.

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Trustee’s Signature

Print/Type preparer’s name

Paid
Preparer
Use Only

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Sign
Here

No

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Name of U.S. agent

c

4a

Yes

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
Summary of all written and oral agreements and understandings relating to the trust? . . .

Title

Preparer’s signature

Date

Check
if
self-employed

Firm’s name ▶

Firm’s EIN

Firm’s address ▶

Phone no.

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 19595G

Date

PTIN

▶

Form

3520-A (2015)

Form 3520-A (2015)

Income

Part II
1
2

Interest .
Dividends

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Gross rents and royalties . . . . . . .
Income (loss) from partnerships and fiduciaries
Capital gains:

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Net short-term capital gain (loss) .
Net long-term capital gain (loss) .
Ordinary gains (losses) . . . .

a
b
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7
8
9

Expenses

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Other income (attach statement) . .
Total income (add lines 1 through 7) .

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Interest expense

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10a
b
11

Foreign taxes (attach statement) . . .
State and local taxes . . . . . .
Amortization and depreciation (depletion)

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12
13
14

Trustee and advisor fees . . . . . .
Charitable contributions . . . . . .
Other expenses (attach statement) . . .
Total expenses (add lines 9 through 14) . .
Net income (loss) (subtract line 15 from line 8)

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

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16
17a
b

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(i) Name of owner

c

2

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

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(ii) Identification number

(iii) Date of distribution

(iv) FMV

(ii) Identification number

(iii) Date of distribution

(iv) FMV

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

Part III

Foreign Trust Balance Sheet

Beginning of Tax Year

Assets

(a)

1
2
3
4
5
6
7
8a
b
9
10
11

Cash
. . . . . . . . . . .
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 statement) . . . .
Total assets
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12
13
14
15
16

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

17
18
19
20
21

Contributions to trust corpus
. . . . . .
Accumulated trust income . . . . . . .
Other (attach statement) . . . . . . . .
Total net worth (add lines 17 through 19) . . .
Total liabilities and net worth (add lines 16 and 20)

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(b)

End of Tax Year
(c)

(d)

Liabilities
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Net Worth

Form

3520-A (2015)

Form 3520-A (2015)

Page

3

2015 Foreign Grantor Trust Owner Statement (see instructions)
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(1)

Employer identification number

c

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

b(2)

Reference ID number (see instructions)

d

City or town

e State or province

f ZIP or foreign postal code

g

Country

2

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.

3a

Name of U.S. agent

c

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

d

City or town

4a

e State or province

f ZIP or postal code

Name of trustee

c

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

d

City or town

5
6a

e State or province

f ZIP or postal code

The tax year of the owner of the foreign trust to which this statement relates
Name of U.S. owner

c

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

d

City or town

h

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

e State or province

Yes

b

Identification number

g

Country

b

Identification number (if any)

g

Country

b

Identification number

g

Country

No

▶

f ZIP or postal code
▶

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 .

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$

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2015 Statement of Foreign Trust Income Attributable to U.S. Owner (see instructions)

Expenses

Income

Report each item on the proper form or schedule of your tax return.
1a
b

Taxable interest . . .
Tax-exempt interest ▶

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2a
b

Total ordinary dividends .
Qualified dividends ▶

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3
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Gross rents and royalties . . . . .
Income from partnerships and fiduciaries .

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5
6
7

Capital gains (losses)
. . .
Ordinary gains (losses) . . .
Other income (attach statement)

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8
9a
b

Interest expense . . . . .
Foreign taxes (attach statement)
State and local taxes
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Amortization and depreciation (depletion)
Trustee and advisor fees. . . . . .
Charitable contributions . . . . . .
Other expenses (attach statement) . . .

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10
11
12
13

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 (2015)

Form 3520-A (2015)

Page

4

2015 Foreign Grantor Trust Beneficiary Statement
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. Each U.S. beneficiary must attach a copy of its statement to its Form 3520.
1a

Name of foreign trust

b(1)

Employer identification number

c

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

b(2)

Reference ID number (see instructions)

d

City or town

2

e State or province

f ZIP or foreign 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
c

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

d

City or town

4a

e State or province

f ZIP or postal code

Name of trustee

c

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

d

City or town

5
6a

7

Name of U.S. agent

e State or province

f ZIP or postal code

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

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

Yes

No

Yes

No

b

Identification number

g

Country

b

Identification number (if any)

g

Country

b

Identification number

g

Country

Description of trust property (including cash) that was either (1) distributed, or treated as distributed, directly or indirectly to the U.S. person
who is a beneficiary of the trust or a U.S. person related to that U.S. person during the tax year or (2) used by the U.S. person who is a
beneficiary of the trust or a U.S. person related to that U.S. person without compensating the trust for the FMV of the use of the property within
a reasonable period of time. (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

3520-A (2015)