OMB No. 1545-1806
Asset Allocation Statement
Under Section 338
Department of the Treasury
Internal Revenue Service
Attach to your income tax return. See separate instructions.
Name as shown on return
Check applicable box (see instructions):
Filer’s Identifying Information
2a 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
Form 8883 (10-2002)
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 33707Y
Identifying number as shown on return
Target Corporation’s Identifying Information
3a Name and address of target corporation
3c State or country of incorporation
5a Stock price
5b Acquisition costs/Selling costs 5c Target liabilities
Employer identification number
Other Party’s Identifying Information
Part IV General Information
4a Acquisition date
4b What percentage of target corporation stock was
During the 12-month acquisition period?
On the acquisition date?
6 Was the filer listed in Part I, above, a member of an affiliated group of corporations before the acquisition date?
Was the target corporation a member of an affiliated group before the acquisition date?
Is the target corporation or any target affiliate:
a A controlled foreign corporation? If “No,” check here if it was a CFC at any time during the preceding 5 years
b A foreign corporation with income, gain, or loss effectively connected with the conduct of a trade or business within
the United States (including U.S. real property interests)?
c A qualifying foreign target under Regulations section 1.338-2(e)(1)(iii)?
A corporation to which section 936 applies?
A corporation electing under section 1504(d) or section 953(d)?
A domestic international sales corporation (DISC)?
A passive foreign investment company (PFIC)?
If the answer to item 8g is “Yes”, is the PFIC a pedigreed qualif