Page 25 - IRS Individual Tax Forms
P. 25

Form 965-A (Rev.1-2020)                                                                                    Page 3
       Part IV  Annual Report of Deferred Net 965 Tax Liability Related to 965 Amounts Allocated From S Corporations
              (required every year until the liability is fully paid)
                (a)                              (b)                                (c)                   (
               Election                      S Corporation Name                  S Corporation      d)  Beginning
                or                                                             Tax Identification Number  Deferred  Net
               Transfer                                                                             965 Tax
                Year                                                                                Liability
                                                                                                     (see instructions)
        1                                                                                                           1
        2                                                                                                           2
        3                                                                                                           3
        4                                                                                                           4
        5                                                                                                           5
        6                                                                                                           6
        7                                                                                                           7
        8                                                                                                           8
        9                                                                                                           9
       10                                                                                                           10
                    (e)                    (f)                   (g)                (h)                (i)
                                                                               Tax Identification Number
                Reserved for Future Use  Net 965 Tax         Deferred 965 Net Tax   of Transferee or Transferor  Deferred Net Tax Liability
                                          Liability
                                         Triggered          Liability  Transferred (Out)          at the end of this Reporting
                                        (see instructions)       or                              Year  (add columns (d), (e), (f),
                                                          Transferred In by Agreement, if any     and (g))  (see instructions)
                                                              (see instructions)
        1                       (                                                                                   1
                                )
        2                       (                                                                                   2

                                )
        3                       (                                                                                   3

                                )
       If more lines are needed for any Part on this form, attach additional sheets.
                                                                                                                    4
        4                       (                                                                       Form 965-A (Rev.1-2020)
                                )
        5                       (                                                                                   5

                                )
        6                       (                                                                                   6

                                )
        7                       (                                                                                   7

                                )
        8                       (                                                                                   8

                                )
        9                       (                                                                                   9

                                )
       10                       (                                                                                   10

                                )
        Total .  .  .  .  .  . .  .  .  .  . . .  .  .  .  .  .  .  .  .  .  . . .  .  .  .  .  .  .  .  .  .  . . .  .  .  .  .  .  ▶
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