Annual Information Return of

Foreign Trust With a U.S. Owner

Form 3520-A OMB No. 1545-0160

Department of the Treasury

Internal Revenue Service

© Certain foreign trusts may have to issue a Foreign Grantor Trust Owner Statement(s) or

a Foreign Grantor Trust Beneficiary Statement(s) (pages 3 and 4). See separate instructions.

Note: All information must be in English. Show all amounts in U.S. dollars.

For calendar year 1997, or tax year beginning , 19 , and ending , 19 .

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge

and belief, it is true, correct, and complete.

Title Date

Trustee’s

Signature

For Paperwork Reduction Act Notice, see instructions on page 4. Cat. No. 19595G Form 3520-A (1997)

1997

Date

Preparer’s

social security number

Preparer’s

Signature

General Information (See instructions. )

1a Name of foreign trust b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

3a Name of U.S. agent b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

4a Name of trustee b Identification number, if any

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

5 Did the trust transfer any property to another entity during the tax year?

Part I

Did the foreign trust appoint a U.S. agent (defined on page 2 of the instructions) who can provide IRS with all revelant trust

information?

If “Yes,” complete lines 3a through 3g.

Yes No

2

(Under section 6048(b))

Yes No

If “Yes,” attach statement. See instructions.

If “No,” you are required to attach a copy of all trust documents as indicated below. If these documents have been attached to a Form

3520-A filed within the previous 3 years, attach only relevant updates.

Have you attached a copy of:

a Summary of all written and oral agreements and understandings relating to the trust?

Yes No

Attached

Previously

Year

Attached

b The trust instrument?

c Memoranda or letters of wishes?

d Subsequent variances to original trust documents?

e Other trust documents?
Form 3520-A (1997) Page 2

Foreign Trust Income Statement. Totals from books and records of foreign trust. (See instructions.)

Income Expenses

Foreign Trust Balance Sheet Beginning of Tax Year End of Tax Year

(a) Amount (b) Total (c) Amount (d) Total Assets

Liabilities

Part II

1 Interest

2 Dividends

3 Gross rents and royalties

5 Capital gains:

a Net short-term capital gain (loss)

b Net long-term capital gain (loss)

6 Ordinary gains (losses)

7 Other income (attach schedule)

8 Total income (add lines 1 through 7)

9 Interest expense

10a Foreign taxes

b State and local taxes

11 Amortization and depreciation (depletion)

12 Trustee and advisor fees

13 Charitable contributions

14 Other expenses (attach schedule)

15 Total expenses (add lines 9 through 14)

16 Net income (loss) (subtract line 15 from line 8)

17a Enter FMV of total distributions from the trust to all persons whether U.S. or foreign persons ©

(a) Name of owner (b) Identification number (c) Date of distribution

Part III

3 Mortgages and notes receivable

1 Cash

2 Accounts receivable

4 Inventories

5 Government obligations

6 Other marketable securities

7 Other nonmarketable securities

8a Depreciable (depletable) assets

b Less: accumulated depreciation (depletion)

9 Real property

10 Other assets (attach schedule)

11 Total assets

12 Accounts payable

13 Contributions, gifts, grants, etc. payable

14 Mortgages and notes payable

15 Other liabilities (attach schedule)

16 Total liabilities

Net Worth

17 Contributions to trust corpus

18 Accumulated trust income

19 Other (attach schedule)

20 Total net worth (add lines 17 through 19)

21

4 Income (loss) from partnerships and fiduciaries

Distributions to U.S. owner:

Distributions to U.S. beneficiaries

b

c

(d) FMV

(a) Name of beneficiary (b) Identification number (c) Date of distribution (d) FMV

Total liabilities and net worth (add lines 16 and 20)
Form 3520-A (1997) Page 3

1997 Foreign Grantor Trust Owner Statement

1a Name of foreign trust b Identification number

c Number, street, and room or suite no. (if a P.O. box, see page 2 of instructions)

d City or town e State or province f ZIP or postal code g Country

3a Name of U.S. agent b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

4a Name of trustee b Identification number, if any

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

5 The tax year of the owner of the foreign trust to which this statement relates ©

6a Name of U.S. owner b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

9 U.S. owner’s gross reportable amount. (See instructions.) $

1997 Statement of Foreign Trust Income Attributable to U.S. Owner (See instructions.)

1 Interest 

2 Dividends

3 Gross rents and royalties 

5 Capital gains (losses)

6 Ordinary gains and (losses)

7 Other income (attach schedule)

8 Interest expenses

9a Foreign taxes (attach schedule)

b State and local taxes

10 Amortization and depreciation (depletion)

11 Trustee and advisor fees

12 Charitable contributions

13 Other expenses (attach schedule)

Did the foreign trust appoint a U.S. agent (defined on page 2 of the instructions) who can provide IRS with all revelant

trust information?

2

Yes No

If “Yes,” complete lines 3a through 3g.

Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or

portion of the foreign trust) is treated for U.S. tax principles as owned by the U.S. person.

7

4 Income from partnerships and fiduciaries

Income Expenses

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge

and belief, it is true, correct, and complete.

Trustee Signature Title Date

Attach to Form 3520

Report each item on the proper form or schedule of your tax return.

(See instructions.)

8 List the trust documents attached to Form 3520-A.
Form 3520-A (1997) Page 4

1997 Foreign Grantor Trust Beneficiary Statement

1a Name of foreign trust b Identification number

c Number, street, and room or suite no. (if a P.O. box, see page 2 of instructions)

d City or town e State or province f ZIP or postal code g Country

3a Name of U.S. agent b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

4a Name of trustee b Identification number (if any)

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

5 The first and last day of the tax year of the foreign trust to which Form 3520-A applies ©

6a Name of U.S. beneficiary b Identification number

c Number, street, and room or suite no. (if a P.O. box, see instructions)

d City or town e State or province f ZIP or postal code g Country

7 Description of property (including cash) distributed, or treated as distributed, to the U.S. person during the tax year (See instructions to

Part III of Form 3520 for U.S. tax treatment of these amounts.)

(a) Description of property (b) FMV

8 Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (or

portion of the foreign trust) is treated for U.S. tax principles as owned by another person.

9 Owner of the foreign trust is (check one)

individual partnership corporation

Did the foreign trust appoint a U.S. agent (defined on page 2 of the instructions) who can provide IRS with all revelant

trust information? Yes No

If “Yes,” complete lines 3a through 3g.

2

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge

and belief, it is true, correct, and complete.

Trustee Signature © Title © Date ©

Yes No

Attach to Form 3520

If “No,” do you agree that either the IRS or the U.S. beneficiary can inspect and copy the trust’s permanent books of

account, records, and such other documents that are necessary to establish that the trust should be treated for U.S.

tax purposes as owned by another person?