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Enter your data separately for each tax lot (i.e. purchase date):
1. Name of stock sold in partial redemption merger
2. Name of buyer
3. Date of merger (mm/dd/yyyy)
4. Date of original purchase (mm/dd/yyyy) (tax lot)
5. Number of shares owned for this tax lot (no commas)
6. Cost basis for this tax lot before partial redemption merger (total, not per share) $ (no commas)
7. Amount of cash redemption payment per share $ (no commas)
8. Exchange ratio for buyer stock per share (no commas)
Cash ratio for buyer stock per share $ (no commas)
9. Cash received in lieu of fractional share $ (no commas)
10. Cash price for fractional shares $ (no commas)
11. Estimated accumulated earnings and profits (AE&P) per share of seller stock or taxable dividend per share on merger date reported on your Form 1099 $ (no commas)
12. Did you own shares of buyer stock prior to this merger?
13. Account or Owner Name (optional)
Tax information statement