Ownership Disclosure Statement

• Legal Form Number: 6
• Section: Tax Court
• Court: U.S. Tax Court

1UN ITE D S TAT ES TA X C OU RT

WASHINGTON, DC 20217

,

Petitioner(s)

v.

COMMISSIONER OF INTERNAL REVENUE,

Respondent

Docket No.

OWNERSHIP DISCLOSURE STATEMENT

Pursuant to Rule 20(c), Tax Court Rules of Practice and Procedure,

makes the following disclosure:

[If petitioner is a nongovernmental corporation, provide the following information:]

A. All parent corporations, if any, of petitioner, or state that there are no parent corporations:

B. All publicly held entities owning 10 percent or more of petitioner’s stock, or state that there is no

such entity:

OR

[If petitioner is a nongovernmental large partnership or limited liability company, or a tax matters partner or

a partner other than a tax matters partner of a nongovernmental partnership, provide the following information:]

All publicly held entities owning an interest in the large partnership, the limited liability company, or the

partnership, or state that there is no such entity:

Signature of Counsel or Petitioner’s

Duly Authorized Representative

Date

T.C. FORM 6 (REV 05/2012)

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