Form 5713 (Rev. 10-79)

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: Requests | Agreements
Type of participation or cooperation Yes | No | Yes] No
(1) As a condition of doing business directly or indirectly within a country or with the government,
a company, ora national of a country to—
(i) Refrain from doing business with or in a country which is the object of an international
boycott 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?. . . 6 6 ee ee eee ee ee ee .
(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? . . 6 6 ee ee ee ee ee
(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 person

who

does not participate in or cooperate with an international boycott?. . . . . . . |

(b) Requests and agreements.—If the answer to any part of 13(a) is “Yes,

indicate below: the country, the taxpayer iden-

tifying 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 a DISC, ent

er the product

code in column (5). (See Instructions). If necessary, attach additional sheets using the exact format and check this box > ["]

Name of country receiving the

q@)

Taxpayer Type of coor
identifying Principal business activity Discs =

only—
number of person only Requested

Agreed

ion or participation

product
"She agreement’ | Code Description code | Number

(2) (3) (4) () (6)

Code
@.

Number
(8)

Code
(9).

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(b)

(cy

(d)

(e)

a

(e)

(h)

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(m)

(n)

(0)

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283-286-1

‘Yr USS, GOVERNMENT PRINTING OFFICE : 1979-O-283-286


International Boycott Report

For taxable year beginning .....
and ending .....
b> Controlled groups, see specific

To be Filed
in Duplicate
(See Instruction B)

rom D113

‘Taxpayer identifying number

Number and street

City or town, State and ZIP code

Address of Service Center where your tax return is filed

Type of person filing this form (check one):
(7 Individual ( Partnership J Corporation ( Trust (7 Estate ( Other

1 If an individual, enter adjusted gross income from your tax return (see instructions). . . .

2 Partnerships and corporations:
(a) If a partnership.—Enter the name and taxpayer identifying number of each partner,

(b) If a corporation.—Enter the name and employer identification number of all members of the controlled group (as defined in
section 993(a)(3)). If a consolidated return was filed, do not list members included in the consolidated return; instead, at-
tach 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 Form 851 is filed, you must designate a “common taxable year” and enter the name and
employer identification number in line 4(b) of the corporation whose taxable year has been so designated.

Name Taxpayer identifying
number
If necessary, attach additional sheets and check this box. 2 6 6 6 ee ee ee ee oO
Code Description

(c) Enter principal business activity code and description (see instructions). . . .

(d) DISC’s.—Enter principal product or service code and description (see instructions) .
3 Partnerships.—The following information must be submitted by each partnership filing Form 5713:

(a) Enter total assets of the partnership (Form 1065, pagel). . . 2. 1. ee we ee ew

(b) Enter ordinary income of the partnership (Form 1065, pagel). . . . . =. =...
4 Corporations.—The following information must be submitted by every corporation filing Form 5713:

(a) Type of form filed (Form 1120, 1120-DISC, 1120F, 1120L, 1120M, etc.). . . . . « l

(b) Common taxable year election (see instructions) —
(1) Name of corporation >
(2) Employer identification number. . . 2. 1 2 ee ee ee ee
(3) Common taxable year beginning ... and ending ....

(c) Corporations filing this form enter—

(1) Total assets (see instructions). . . . 1. ee ew ee wae oo
(2) Taxable income before net operating loss and special deductions ‘see instructions) .

5 _Fstate or trust.—Enter total income (Form 1041, pagel). . . . . . . - oe
6 Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions):

(a) Foreign tax credit. © 2 6 6 ee ee ee ee ee ee
(b) Deferral of earnings of controlled foreign corporations rs
(c) Deferral of DISC income... - : Ea a

Under penalties of perjury, | declare that I have examined this report, including accempanying schedules and statements, and to the best of my knowledge and belief it is true,
correct, and complete.

Signature m.. -. Date P......

Title >
283-286-2 Form 5713 (Rev. 10-79)



Form 5713 (Rev. 10-79)

Page 2

7 The following information must be submitted by every person filing Form 5713 (see specific instructions): Yes | No
(a) Are you a United States shareholder (as defined in section 951(b)) of any foreign corporation that had reportable
operations under section 999(a)?. 6 6 we we ee ee eee ee ee
(b) If the answer to (a) is “Yes,” is any foreign corporation a controlled foreign corporation (as defined in section
957)
(©) Do you own any stock of aDISC?. . 2. 1 ee ee ee ee Se eee
(d) Do you claim any foreign tax credit?. 6 1 6 6 ee ee ee
(e) Do you control (within the meaning of section 304(c)) any corporation (other than a corporation included in this
report) that has reportable operations under section 999(a)?. . 6 6 6 ee ee ee ee ee
If “Yes,” did the corporation controlled by you participate in or cooperate with an international boycott at any
time during its taxable year that ends with or within your taxable year? . . 1 ew ee ew ew ee ee
(f) Are you controlled (within the meaning of section 304(c)) by any person (other than a person included in this
report) that has reportable operations under section 999(a)?) . 2 1 ee ee ee
If “Yes,” did the person controlling you participate in or cooperate with an international boycott at any time
during its taxable year that ends with or within your taxable year? 2... ee ee ee ee ee ee LL
(g) Are you treated under section 671 as the owner of a trust that has reportable operations under section n 999(a)? « . —
(h) Are you a partner in a partnership that has reportable operations under section 999(a)?._. . - we

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 such country) associated in carrying out the boycott of Israel which is on the list maintained by the Secre- |———|———
tary of the Treasury under section 999(a)(3) (see Instruction C)?. 6. 6 6 6 we ee eee ee ee Ld
If “Yes,” enter name of the country(ies), taxpayer identifying number of person(s) having operations, principal busi-
ness activity code, a description of the principal business activity; and if you are a DISC, enter the product code. If
necessary, attach additional sheets using the exact format and check this box. . . . . + s+ + ee ees -r>o

7 identity ber of Principal business activity Discs
‘axpayer identifying number of
Name of country person(s) having operations Code Description product code
2) @) @ @ @)

@)

(by

(©)

(d)

(e)

)

(g)

(hy

qd)

@)

(k)

(0)

(m)

(n)

(0)

P)

283-286-1


Form 5713 (Rev. 10-79)

Page 3

9 Non-listed countries boycotting Israel.—Did you have operations in any non-listed country which you know or have |_Yes |_No
reason to know requires participation in or cooperation with an international boycott directed against Israel?. . .
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 a DISC, enter the product code. If neces-
sary, attach additional sheets using the exact format and check this box... + + + + + + s+ + + st tt ro
Principal business activity DIScs
T 1 identifying number of —
Name of country ‘Sperson(s) having eperations | code Description poker te
a) (2) @) @ ®
(a)
(b)
(c)
(a)
e)
(f),
(e)
(hy
10 Boycotts other than the boycott of Israel.—Did you have operations in any other country which you know or have |_Yes |_No
reason to know requires participation in or cooperation with an international boycott other than the boycott of Israel? .
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 a DISC, enter the product code. If neces-
sary, attach additional sheets using the exact format and check this box. . . . + + + + + + + + + + + ro

Principal business activity

DIScs

Taxpayer identifying number of
Name of country person(s) having operations Code Description

a (2) (3) (4)

only—Enter
product code

(5)

(a)

(b)

(c)

(a)

(e)

w

(e)

(hy

11 Were you requested to participate in or cooperate with an international boycott? . . . - oe ee ew we
If “Yes,” attach a copy (in English) of any and all such requests received during your taxable year. If the request was
in a 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? . . . rs

Yes |_No

ft
ot

7,

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, B, or C (Form 5713).

283-286-1