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CALCULATOR FOR TAX-FREE STOCK SPLIT-OFFS

Enter your data separately for each tax lot (i.e. purchase date):
1. Name of split-off stock
or enter your own data:
2. Name of original stock
3. Date of split-off (mm/dd/yyyy)
4. Split-off exchange ratio (number of split-off shares received for each original share exchanged)
5. Purchase date for original stock (mm/dd/yyyy)
6. Number of shares of original stock prior to split-off (no commas)
7. Total cost basis for original stock, including commissions and fees, adjusted for previous spinoffs (total, not per share) $ (no commas)
8. Number of shares of original stock accepted for exchange after prorations, if any (no commas)
9. Cash received in lieu of fractional shares (often denoted as CIL) (enter 0.00 if none) $ (no commas)
10. Percentage of shares that were accepted for split-off exchange %
11. Fair market value per share of split-off stock on date of exchange (no commas)
12. Fair market value per share of original stock on date of exchange (no commas)
13. Comments or additional information on terms of split-off (optional) (no commas)
14. Name of tax information statement if available
15. Tax status: 1=fair market value allocation or 3=specific identification carryover
16. Account or Owner Name (optional)