Free Form 8275 (Rev. August 2008) - Federal

Form

8275

Disclosure Statement
Do not use this form to disclose items or positions that are contrary to Treasury regulations. Instead, use Form 8275-R, Regulation Disclosure Statement. See separate instructions. Attach to your tax return.

OMB No. 1545-0889

(Rev. August 2008)

Department of the Treasury Internal Revenue Service

Attachment Sequence No.

92

Name(s) shown on return

Identifying number shown on return

Part I

General Information (see instructions)
(b) Item or Group of Items (c) Detailed Description of Items (d) Form or Schedule (e) Line No. (f) Amount

(a) Rev. Rul., Rev. Proc., etc.

1 2 3 4 5 6

Part II
1

Detailed Explanation (see instructions)

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. 61935M Form

8275

(Rev. 8-2008)

Form 8275 (Rev. 8-2008)

Page

2

Part IV

Explanations (continued from Parts I and/or II)

Form

8275

(Rev. 8-2008)