Form 3520-A
Department of the Treasury
Internal Revenue Service
Annual Information Return of Foreign
Trust With a U.S. Owner
(Under section 6048(b))
Go to www.irs.gov/Form3520A for instructions and the latest information.
OMB No. 1545-0159
2019
Note: All information must be in English. Show all amounts in U.S. dollars.
For calendar year 2019, or tax year beginning , 2019, ending , 20 .
Check appropriate boxes. Initial return Final return Amended return
Check if any excepted specified foreign financial assets are reported on this form (see instructions) . . . . . . . . . . . . . .
Part I General Information (see instructions)
1a Name of foreign trust b(1)
Employer identification number
b(2)
Reference ID number (see instructions)
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f
ZIP or foreign postal code
g Country
2
Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all the relevant
trust information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
If “Yes,” skip lines 2a through 2e and go to line 3.
If “No,” you are required to attach a copy of all trust documents as indicated below. If these documents have been attached to a Form 3520-A
filed within the previous 3 years, attach only relevant updates.
Have you attached a copy of: Yes No
Attached
Previously
Year
Attached
a Summary of all written and oral agreements and understandings relating to the trust? . . .
b The trust instrument? . . . . . . . . . . . . . . . . . . . . . .
c Memoranda or letters of wishes? . . . . . . . . . . . . . . . . . .
d Subsequent variances to original trust documents? . . . . . . . . . . . . .
e
Other trust documents? . . . . . . . . . . . . . . . . . . . . .
3a Name of U.S. agent b Identification number
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
4a Name of trustee b Identification number, if any
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
5
Did the trust transfer (directly or indirectly) any property (including cash) to another person (see instructions for
definition of person) during the foreign trust’s tax year? If “Yes,” attach a statement (see instructions) . . . . .
Yes No
6
Enter the number of Foreign Grantor Trust Owner Statements (pages 3 and 4) included with this Form 3520-A
Sign
Here
Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Trustee’s Signature
Title
Date
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm’s EIN
Phone no.
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 19595G
Form 3520-A (2019)
Form 3520-A (2019)
Page
2
Part II
Foreign Trust Income Statement
Enter totals from books and records of foreign trust (see instructions).
Income
1 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Gross rents and royalties . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Income (loss) from partnerships and fiduciaries . . . . . . . . . . . . . . . . . . . .
5 Capital gains:
a Net short-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . .
b Net long-term capital gain (loss) . . . . . . . . . . . . . . . . . . . . . . . .
6 Ordinary gains (losses) . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Other income (attach statement) . . . . . . . . . . . . . . . . . . . . . . . .
8 Total income (add lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . .
Expenses
9 Interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
a Foreign taxes (attach statement) . . . . . . . . . . . . . . . . . . . . . . . .
b State and local taxes . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
Amortization and depreciation (depletion) . . . . . . . . . . . . . . . . . . . . .
12
Trustee and advisor fees . . . . . . . . . . . . . . . . . . . . . . . . . .
13
Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Other expenses (attach statement) . . . . . . . . . . . . . . . . . . . . . . .
15 Total expenses (add lines 9 through 14) . . . . . . . . . . . . . . . . . . . . . .
16 Net income (loss) (subtract line 15 from line 8) . . . . . . . . . . . . . . . . . . . .
17a
Enter the fair market value (FMV) of total distributions (directly or indirectly) from the trust to all persons, whether
U.S. or foreign. See instructions for definitions of distribution and person . . . . . . . . . . .
b Distributions to U.S. owners:
(i) Name of owner (ii) Identification number (iii) Date of distribution (iv) FMV on date of distribution
c Distributions to U.S. beneficiaries:
(i) Name of beneficiary (ii) Identification number (iii) Date of distribution (iv) FMV on date of distribution
Part III
Foreign Trust Balance Sheet
Beginning of Tax Year End of Tax Year
Assets
(a) (b) (c) (d)
1 Cash . . . . . . . . . . . . .
2 Accounts receivable . . . . . . . . .
3 Mortgages and notes receivable . . . . .
4 Inventories . . . . . . . . . . . .
5 Government obligations . . . . . . . .
6 Other marketable securities . . . . . . .
7 Other nonmarketable securities . . . . . .
8a Depreciable (depletable) assets . . . . . .
b Less: accumulated depreciation (depletion) . .
9 Real property . . . . . . . . . . .
10 Other assets (attach statement) . . . . . .
11 Total assets . . . . . . . . . . .
Liabilities
12 Accounts payable . . . . . . . . . .
13 Contributions, gifts, grants, etc., payable . . .
14 Mortgages and notes payable . . . . . .
15 Other liabilities (attach statement) . . . . .
16 Total liabilities . . . . . . . . . . .
Net Worth
17 Contributions to trust corpus . . . . . .
18 Accumulated trust income . . . . . . .
19 Other (attach statement) . . . . . . . .
20 Total net worth (add lines 17 through 19) . . .
21
Total liabilities and net worth (add lines 16 and 20)
Form 3520-A (2019)
Form 3520-A (2019)
Page 3
2019 Foreign Grantor Trust Owner Statement (see instructions)
Important: Trustee must prepare a separate statement for each U.S. owner and include a copy of each statement with Form 3520-A. Trustee is also
required to send to each U.S. owner a copy of the owner’s statement. U.S. owner must attach a copy of its statement to Form 3520.
1a Name of foreign trust b(1) Employer identification number
b(2)
Reference ID number (see instructions)
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f
ZIP or foreign postal code
g Country
2
Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust information?
If “Yes,” complete lines 3a through 3g.
Yes No
3a Name of U.S. agent b Identification number
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
4a Name of trustee b Identification number (if any)
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
5 The first and last day of the tax year of the foreign trust to which this statement relates
6a Name of U.S. owner b Identification number
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
h Service Center where U.S. owner files its income tax returns
7 Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or portion
of the foreign trust) is treated for U.S. tax principles as owned by the U.S. person.
8 If the trust did not appoint a U.S. agent, list the trust documents attached to Form 3520-A (see instructions).
9 Gross value of the portion of the trust treated as owned by the U.S. owner . . . . . . . $
10
Cash amounts or FMV of property distributed, directly or indirectly, during the foreign trust’s tax year, from the foreign trust (exclude loans) to
the U.S. owner.
(a)
Date of distribution
(b)
Description of property distributed
(c)
FMV of property distributed
(determined on date of distribution)
(d)
Description of property
transferred, if any
(e)
FMV of property
transferred
(f)
Excess of column (c)
over column (e)
Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Form 3520-A (2019)
Form 3520-A (2019)
Page 4
2019 Statement of Foreign Trust Income Attributable to U.S. Owner (see instructions)
Report each item on the proper form or schedule of your tax return.
Income
1a Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Tax-exempt interest
2a Total ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Qualified dividends
3 Gross rents and royalties . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Income from partnerships and fiduciaries . . . . . . . . . . . . . . . . . . . . . .
5 Capital gains (losses) . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Ordinary gains (losses) . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Other income (attach statement) . . . . . . . . . . . . . . . . . . . . . . . .
8 Total income. Add lines 1 through 7 . . . . . . . . . . . . . . . . . . . . . .
Expenses
9 Interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10a Foreign taxes (attach statement) . . . . . . . . . . . . . . . . . . . . . . . .
b State and local taxes . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Amortization and depreciation (depletion) . . . . . . . . . . . . . . . . . . . . .
12 Trustee and advisor fees. . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 Other expenses (attach statement) . . . . . . . . . . . . . . . . . . . . . . . .
15 Total expenses. Add lines 9 through 14 . . . . . . . . . . . . . . . . . . . . .
Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge and
belief, it is true, correct, and complete.
Trustee Signature
Title
Date
Form 3520-A (2019)
Form 3520-A (2019)
Page 5
2019 Foreign Grantor Trust Beneficiary Statement
Important: Trustee must prepare a separate statement for each U.S. beneficiary that received a distribution from the trust during the tax year and
include a copy of each statement with Form 3520-A. Trustee is also required to send to each such beneficiary a copy of the beneficiary’s
statement. Each U.S. beneficiary must attach a copy of its statement to its Form 3520.
1a Name of foreign trust b(1) Employer identification number
b(2)
Reference ID number (see instructions)
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f
ZIP or foreign postal code
g Country
2
Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust
information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
If “Yes,” complete lines 3a through 3g.
If “No,” do you agree that either the IRS or the U.S. beneficiary can inspect and copy the trust’s permanent books of
account, records, and such other documents that are necessary to establish that the trust should be treated for U.S.
tax purposes as owned by another person? . . . . . . . . . . . . . . . . . . . . . .
Yes No
3a Name of U.S. agent b Identification number
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
4a Name of trustee b Identification number (if any)
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
5 The first and last day of the tax year of the foreign trust to which Form 3520-A applies
6a Name of U.S. beneficiary b Identification number
c Number, street, and room or suite no. (if a P.O. box, see instructions)
d City or town e State or province f ZIP or postal code g Country
7
Cash amounts or FMV of property that during the current tax year was: (1) distributed directly or indirectly to a U.S. person whether or not the
U.S. person is designated as a beneficiary of the trust, (2) loaned (exclude loans treated as qualified obligations) directly or indirectly to the
U.S. person who is a beneficiary of the trust or a U.S. person related to that U.S. person, or (3) used by the U.S. person who is a beneficiary of
the trust or a U.S. person related to that U.S. person without compensating the trust for the FMV of the use of the property within a reasonable
period of time. (See the instructions for Part III of Form 3520 for U.S. tax treatment of these amounts).
(a)
Date of distribution
(b)
Description of property distributed
(c)
FMV of property distributed
(determined on date of distribution)
(d)
Description of property
transferred, if any
(e)
FMV of property
transferred
(f)
Excess of column (c)
over column (e)
Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
8
Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or portion
of the foreign trust) is treated for U.S. tax principles as owned by another person.
9 Owner of the foreign trust is (check one):
Individual Partnership Corporation
Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge and
belief, it is true, correct, and complete.
Trustee Signature
Title
Date
Form 3520-A (2019)