Form 8975
(June 2017)
Department of the Treasury
Internal Revenue Service
Country-by-Country Report
Information about Form 8975 and its separate instructions is at www.irs.gov/form8975.
OMB No. 1545-2272
For reporting period beginning , 20 , and ending , 20
If this is an amended report, check here
Enter the number of Schedules A (Form 8975) attached to this Form 8975
Part I Identification of Filer
1a
Name of the reporting entity 1b Reporting role code 1c EIN
2
Number, street, and room or suite no. (if P.O. box, see instructions)
3a
City or town 3b State or province 3c Country, and ZIP or foreign postal code
Part II
Additional Information
Enter any additional information related to the multinational enterprise group.
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 37798N
Form 8975 (6-2017)
Form 8975 (6-2017)
Page
2
Part II
Additional Information (continued)
Form 8975 (6-2017)
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