12
I.R.S. SPECIFICATIONS
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INSTRUCTIONS TO PRINTERS
Form 8886, PAGE 1 of 2
MARGINS: TOP 13 mm (
1
⁄ 2 "), CENTER SIDES. PRINTS: HEAD TO FOOT
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216 mm (8
1
⁄ 2 ") x 559 mm (22") FOLD TO: 216 mm (8
1
⁄ 2 ") x 279 mm (11")
PERFORATE: (ON FOLD)
Form
8886
(Rev. December 2007)
Reportable Transaction Disclosure Statement
Department of the Treasury
Internal Revenue Service
OMB No. 1545-1800
Attachment
Sequence No.
137
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 34654G
�
Attach to your tax return.
�
See separate instructions.
Name(s) shown on return (individuals enter last name, first name, middle initial)
Identifying number
Number, street, and room or suite no.
City or town, state, and ZIP code
A
If you are filing more than one Form 8886 with your tax return, sequentially number each Form 8886 and
enter the statement number for this Form 8886
�
Statement number of
B Enter the form number of the tax return to which this form is attached or related
�
Enter the year of the tax return identified above
�
Is this Form 8886 being filed with an amended tax return? Yes No
C Check the box(es) that apply (see instructions).
Initial year filer
Protective disclosure
1a Name of reportable transaction
1b Initial year participated in transaction 1c Reportable transaction or tax shelter registration number
(9 digits or 11 digits)
2 Identify the type of reportable transaction. Check all boxes that apply (see instructions).
a
Listed
b
Confidential
c Contractual protection
d Loss
e
Brief asset holding period
f
Transaction of interest
3 If you checked box 2a or 2f, enter the published guidance number for the listed transaction or transaction
of interest �
4
Enter the number of “same as or substantially similar” transactions reported on this form
�
5
If you participated in the transaction through another entity, check all applicable boxes and provide the information below for the
entity (see instructions). (Attach additional sheets, if necessary.)
a Type of entity: Partnership
S corporation
Trust
Foreign
Partnership
S corporation
Trust
Foreign
b Name
�
c Employer identification number (EIN), if
known
�
d Date Schedule K-1 received from entity
(enter
“none” if Schedule K-1 not
received)
�
6 Enter below the name and address of each individual or entity to whom you paid a fee with regard to the transaction if that
individual or entity promoted, solicited, or recommended your participation in the transaction, or provided tax advice related to the
transaction. (Attach additional sheets, if necessary.)
a
Name
Identifying number (if known) Fees paid
$
Number, street, and room or suite no.
City or town, state, and ZIP code
b
Name
Identifying number (if known)
Fees paid
$
Number, street, and room or suite no.
City or town, state, and ZIP code
Form 8886 (Rev. 12-2007)
