Organization or Reorganization of Foreign Corporation, and Acquisitions and Dispositions of Its Stock

• Legal Form Number: 5471 (Schedule O)
• Year: 2012
• Issuer: Treasury Department
• Section: Treasury Department

SCHEDULE O

(Form 5471)

(Rev. December 2012)

Department of the Treasury

Internal Revenue Service

Organization or Reorganization of Foreign

Corporation, and Acquisitions and

Dispositions of its Stock

Information about Schedule O (Form 5471) and its instructions is at www.irs.gov/form5471

▶ Attach to Form 5471.

OMB No. 1545-0704

Name of person filing Form 5471 Identifying number

Name of foreign corporation EIN (if any) Reference ID number (see instructions)

Important: Complete a separate Schedule O for each foreign corporation for which information must be reported.

Part I To Be Completed by U.S. Officers and Directors

(a)

Name of shareholder for whom

acquisition information is reported

(b)

Address of shareholder

(c)

Identifying number

of shareholder

(d)

Date of original

10% acquisition

(e)

Date of additional

10% acquisition

Part II To Be Completed by U.S. Shareholders

Note: If this return is required because one or more shareholders became U.S. persons, attach a list showing the names

of such persons and the date each became a U.S. person.

Section A—General Shareholder Information

(a)

Name, address, and identifying number of

shareholder(s) filing this schedule

(b)

For shareholder’s latest U.S. income tax return filed, indicate:

(1)

Type of return

(enter form number)

(2)

Date return filed

(3)

Internal Revenue Service Center

where filed

(c)

Date (if any) shareholder

last filed information

return under section 6046

for the foreign corporation

Section B—U.S. Persons Who Are Officers or Directors of the Foreign Corporation

(a)

Name of U.S. officer or director

(b)

Address

(c)

Social security number

(d)

Check appropriate

box(es)

Officer Director

Section C—Acquisition of Stock

(a)

Name of shareholder(s) filing this schedule

(b)

Class of stock

acquired

(c)

Date of

acquisition

(d)

Method of

acquisition

(e)

Number of shares acquired

(1)

Directly

(2)

Indirectly

(3)

Constructively

For Paperwork Reduction Act Notice, see the Instructions for Form 5471. Cat. No. 61200O Schedule O (Form 5471) (Rev. 12-2012)