8975 Country-by-Country Report

Form

8975

(Rev. December 2020)

Country-by-Country Report
For reporting period beginning

Department of the Treasury
Internal Revenue Service

, 20

, and ending

OMB No. 1545-2272

, 20

▶ Go to www.irs.gov/Form8975 for instructions and the latest information.

If this is an amended report, check here
Enter the number of Schedules A (Form 8975) attached to this Form 8975 ▶

Part I

Identification of Filer

1a Name of the reporting entity
2

1c EIN

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

3a City or town
4

1b Reporting role code

3b State or province

3c Country, and ZIP or foreign postal code

Name of the U.S. Multinational Enterprise (MNE) group (if different from reporting entity)

Part II

Additional Information

Enter any additional information related to the U.S. MNE group

For Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 37798N

Form 8975 (Rev. 12-2020)

Form 8975 (Rev. 12-2020)

Part II

Page 2

Additional Information (continued)

Form 8975 (Rev. 12-2020)