Instructions for Form 8275-R, Regulation Disclosure Statement

Legal Form Number8275-R
Year2013
IssuerTreasury Department
SectionTreasury Department
Form 8275-R
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Regulation Disclosure Statement
Use this form only to disclose items or positions that are contrary to Treasury
regulations. For other disclosures, use Form 8275, Disclosure Statement.
Information about Form 8275-R and its separate instructions is at www.irs.gov/form8275.
Attach to your tax return.
OMB No. 1545-0889
Attachment
Sequence No. 92A
Name(s) shown on return Identifying number shown on return
If Form 8275-R relates to an information return for a foreign entity (for example, Form 5471), enter:
Name of foreign entity
Employer identification number, if any
Reference ID number (see instructions)
Part I General Information (see instructions)
(a)
Regulation Section
(b)
Item or Group
of Items
(c)
Detailed Description
of Items
(d)
Form or
Schedule
(e)
Line
No.
(f)
Amount
1
2
3
4
5
6
Part II Detailed Explanation (see instructions)
1
2
3
4
5
6
Part III Information About Pass-Through Entity. To be completed by partners, shareholders, beneficiaries,
or residual interest holders.
Complete this part only if you are making adequate disclosure for a pass-through item.
Note: A pass-through entity is a partnership, S corporation, estate, trust, regulated investment company (RIC), real estate investment
trust (REIT), or real estate mortgage investment conduit (REMIC).
1 Name, address, and ZIP code of pass-through entity 2 Identifying number of pass-through entity
3 Tax year of pass-through entity
/ / to / /
4 Internal Revenue Service Center where the pass-through entity filed
its return
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 14594X Form 8275-R (Rev. 8-2013)

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