(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Do not use this form to disclose items or positions that are contrary to Treasury
regulations. Instead, use Form 8275-R, Regulation Disclosure Statement.
Information about Form 8275 and its separate instructions is at www.irs.gov/form8275.
Attach to your tax return.
OMB No. 1545-0889
Sequence No. 92
Name(s) shown on return Identifying number shown on return
If Form 8275 relates to an information return for a foreign entity (for example, Form 5471), enter:
Name of foreign entity
Employer identification number, if any
Reference ID number (see instructions)
Part I General Information (see instructions)
Rev. Rul., Rev. Proc., etc.
Item or Group
Part II Detailed Explanation (see instructions)
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).
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
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 61935M
Form 8275 (Rev. 8-2013)