(Rev. December 2012)
Department of the Treasury
Internal Revenue Service
Asset Acquisition Statement
Under Section 1060
Attach to your income tax return.
Information about Form 8594 and its separate instructions is at www.irs.gov/form8594
OMB No. 1545-1021
Name as shown on return Identifying number as shown on return
Check the box that identifies you:
Name of other party to the transaction Other party’s identifying number
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
Date of sale
Total sales price (consideration)
Original Statement of Assets Transferred
Aggregate fair market value (actual amount for Class I) Allocation of sales price
Class I $ $
Class II $ $
Class III $ $
Class IV $ $
Class V $ $
Class VI and VII $ $
Total $ $
Did the purchaser and seller provide for an allocation of the sales price in the sales contract or in another
written document signed by both parties? . . . . . . . . . . . . . . . . . . . . . .
If “Yes,” are the aggregate fair market values (FMV) listed for each of asset Classes I, II, III, IV, V, VI, and VII
the amounts agreed upon in your sales contract or in a separate written document? . . . . . . . .
In the purchase of the group of assets (or stock), did the purchaser also purchase a license or a covenant
not to compete, or enter into a lease agreement, employment contract, management contract, or similar
arrangement with the seller (or managers, directors, owners, or employees of the seller)? . . . . . .
If “Yes,” attach a statement that specifies (a) the type of agreement and (b) the maximum amount of
consideration (not including interest) paid or to be paid under the agreement. See instructions.
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 63768Z
Form 8594 (Rev. 12-2012)