Form 926 Organizer

YOUR NAME:

SOCIAL SECURITY NUMBER:

ADDRESS (PER TAX RETURN):

RE FOREIGN TRANSFEREE - CORPORATION OR OTHER ENTITY

NAME AND ADDRESS

FEDERAL IDENTIFICATION NUMBER, IF ANY:
COUNTRY IN WHICH INCORPORATED:

LIST:

• ASSETS TRANSFERRED AND ALL RELEVANT DETAILS
• NUMBER OF ITEMS TRANSFERRED
• AGREED VALUE OF TRANSFER
• BASIS OF VALUATION
• FAIR MARKET VALUE OF ITEMS TRANSFERRED
• DATE OF TRANSFER

Attach a Balance Sheet of the transferee corporation, as at the date immediately after the transfer.

Angus McDowell, McDowell CPA PC
410 Park Avenue, suite 1530, New York, NY 10022-9441
Telephone 1 212 949 1966 Fax 1 212 949 1494 e-mail angus@mcdowell.com
Copyright 1992 through 2003