Form 5713 (Rev. 1-86)

Page 4

Requests for and Acts of Participation in or Cooperation with an International Boycott
13 a Did you receive requests to enter into, or, in fact, enter into any agreement (See instruction F.3 Requests | Agreements
and F.5):
Type of participation or cooperation Yes | No | Yes| No

(1) Asa condition of doing business directly or indirectly within a country or with the government, a
company, or a national of a country to—
(i) Refrain from doing business with or in a country which is the object of an an international boycott or or

with the government, companies, or nationals of that country?

(ii) Refrain from doing business with any United States person engaged in trade in a country which is the
object of an international boycott or with the government, companies, or nationals of that country? .

(iii) Refrain from doing business with any company whose ownership or management is made up, all or
in part, of individuals of a particular nationality, race, or religion, or to remove (or refrain from
selecting) corporate directors who are individuals of a particular nationality, race, or religion?

(iv) Refrain from employing individuals of a particular nationality, race, or religion?

(2) As a condition of the sale of a product to the government, a company, or a national of a country, to
refrain from shipping or insuring products on a carrier owned, leased or operated by a 2 person who
does not participate in or cooperate with an international boycott? sone

Requests and agreements.—If the answer to any part of 13a is ‘‘Yes,"’ indicate below: the country, the taxpayer identifying

number, principal business activity code, description of the principal business activity, the number and the number code

indicating the type of participation or cooperation requested or agreed to. Also, if you are an IC-DISC, enter the product code

in column (5). (See Instructions.) If necessary, attach additional sheets using the exact format and check this box > Oo
Taxpayer ientiing Principal business sty leases ‘Type of cooperation or participation
Name of country the requestor having Enter [__ Number of requests | Number of agreements
the agreement Code Description Sroduct Total Code | Total ‘| Code

qa) @) (c) (4) @) ©) @ @ Y



rom 9713 International Boycott Report OMB No, 5450216
(Rev. January 1986) For tax year beginning xpires 10-314
and ending ___

To be Filed
in Duplicate
(See Instruction B)

Name Taxpayer identifying number

Department of the Treasury

Internal Revenue Service » Controlled groups, see specific instructions.

Number and street

City or town, state and ZIP code

Address of Service Center where your tax return is filed

Type of filer (check one):
(1 Individual 0 Partnership O Corporation OO Trust O Estate O Other

1 Individuals.—Enter adjusted gross income from your tax return (see instructions) .

2 Partnerships and corporations:
a Partnerships.—Enter each partner's name and taxpayer identifying number.
b Corporations.—Enter the name and employer identification number of each member of the controlled group (as defined in

section 993(a)(3)). Do not list members included in the consolidated return; instead, attach a copy of Form 851. List all other
members of the controlled group not included in the consolidated return.

If you list any corporations below or if you attach Form 851, you must designate a “‘common taxable year.” Enter the name
and employer identifi: line 4b of the corporation whose taxable year is designated.
Name Taxpayer identifying number

\f necessary, attach more sheets andcheckthisbox . 2 2 2 1. ee ee ee ee
Code Description

¢ Enter principal business activity code and description (see instructions) . .
d__1C-DISCs.—Enter principal product or service code and description (see instructions)
3 Partnerships.—Each partnership filing Form 5713 must give the following information:

a Partnership's total assets (Form 1065, pagel). .
b_ Partnership's ordinary income (Form 1065, page 1)

4 Corporations.—Each corporation filing Form 5713 must give the following information:
a_ Type of form filed (Form 1120, 1120-IC-DISC, 1120F, 1120-FSC, 1120L, 1120M, etc). . Le
b Common taxable year election (see instructions)—
(1) Name of corporation >
(2) Employer identification number
(3) Common taxable year beginning _
c Corporations filing this form enter—

(1) Total assets (see instructions)
(2) Taxable income before net operating loss ‘and special deductions (see instructions)

and ending

5 Estates or trusts. —Enter total income (Form 1041, page 1) .

6 Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions):
a Foreign tax credit
b Deferral of earnings of controlled foreign corporations .
¢ Deferral of IC-DISC income
d_ Exempt FSC Income.

Under penalties of perjury, | declare that | have examined this report, including accompanying schedules and statements, and to the best of my knowledge and belief itis true,
correct, and complete,

Signature > Date >

Title >
For Paperwork Reduction Act Notice, see page 1 of the instructions. Form 5713 (Rev. 1-86)



Form 5713 (Rev. 1-86) Page 2
Yes | No

7 The following information must be submitted by every person filing Form 5713 (see specific instructions):
a Are youa United States shareholder (as defined in section 951(b)) of any foreign corporation (including a FSC that does

not use the administrative pricing rules) that had operations reportable under section 999(a)?.

If so, is any foreign corporation a controlled foreign corporation (as defined in section 957(a))?

Do you own any stock of an IC-DISC? . woe

Do you claim any foreign tax credit? .

Do you control (within the meaning of section 304(c)) any corporation (other than a corporation included i in n this report)

that has operations reportable under section 999(a)? .

If “Yes,”’ did the corporation controlled by you participate in or cooperate with an international boycott atany| time.

during its tax year that ends with or within your tax year?

f Are you controlled (within the meaning of section 304(c)) by any person (other than 2 a person included ir in this report)
who has operations reportable under section 999(a)?. . . . . a
If “Yes,” did the person controlling you participate in or cooperate with a an international ‘boycott atany time during its
tax year that ends with or within your tax year? . .

g Are you treated under section 671 as the owner of a trust that has: operations reportable under section 990007.

h_ Are you a partner in a partnership that has operations reportable under section 999(a)?
i__Are you a foreign sales corporation (FSC) (as defined in section 922(a))?

eoaoc

Operations in or Related to a Boycotting Country (See Instructions)

8 Boycott of Israel.—Did you have any operations in or related to any country (or with the government, a company ora Yes | No

national of that country) associated in carrying out the boycott of Israel which is on the list maintained by the Secretary of
the Treasury under section 999(a)(3) (see Instruction C)? :
If “Yes,” enter name of the country(ies), taxpayer identifying number of person(s) having operations, principal business
activity code, a description of the principal business activity; and if you are an IC-DISC, enter the product code. If necessary,
attach additional sheets using the exact format and check thisbox 2. 2... we ee oO

Taxpayer identifying number of Principal business activity Ic-DIscs

Name of country person(s) having operations only—Enter
Code Description product code

() (2) iC) (4) ©)



Form 5713 (Rev. 1-86)

Page 3

9 Non-listed countries boycotting Israel.—Did you have operations in any non-listed country which you know or have reason |¥es | No
to know requires participation in or cooperation with an international boycott directed against Israel? rn . —
If “Yes,” enter the country(ies), taxpayer identifying number of person(s) having operations, the principal business activity
code, a description of the principal business activity; and if you are an IC-DISC, enter the Product code. If necessary, attach
additional sheets using the exact format and check this box rere ee woe > O
Taxpayer identifying number of Principal business iy IC-DISts
Name of country person(s) having operations conly—Enter
Code Description product code
qd) @) (C] (4) (5)
a
b
c
d
e
ft
&
h
10 Boycotts other than the boycott of Israel.—Did you have operations in any other country which you know or have reason to Yes | No
know requires participation in or cooperation with an international boycott other than the boycott of Israel? oe —
If Yes,” enter the country(ies), taxpayer identifying number of person(s) having operations, the principal business activity
code, a description of the principal business activity; and if you are an IC-DISC, enter the Product co code. If necessary, attach
additional sheets using the exact format and check this box oe > Oo
Taxpayer identifying number of ~Pinpa business activity Ic-Dists
Name of country person(s) having operations only—Enter
Code Description product code
@ (2) (3) (4) (6)
a
b .
c
d
e
f
&
h
Yes | No

11 Were you requested to participate in or cooperate with an international boycott? .
If “Yes,” attach a copy (in English) of any and all such requests received during your tax year. tf the request was ina form
other than a written request, attach a separate sheet explaining the nature and form of any and all such requests. (See
Instructions.)

12 Did you, in fact, participate in or cooperate with an international boycott?

If “Yes,” attach a copy (in English) of any and all boycott clauses agreed to, and attach a general statement of the agreement. If the
agreement was in a form other than a written agreement, attach a separate sheet explaining the nature and form of any and all such

agreements. (See Instructions.)

Note: /f the answer to either question 11 or 12 is ‘‘Yes,"’ you must complete the rest of Form 5713. If you answered ‘‘Yes" to question 12,

you must complete Schedules A or B and C (Form 5713).