Form 5713 (Rev. 1-85)

GEG) —sRequests 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 m 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 ina 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) Asa 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 W 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 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 a 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 identifying Dists Type of cooperation or participation

‘number of person receiving Principal business activity only

Name of country the request or having Enter Number of requests

Number of agreements

@ @ @ 4 (5) © ”

the agreement Code Description meodect Total Code

Total Code
@ (C]

(a)

(b)

(c)

@

10)

(g)

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@

@

(k)

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(m)

(n)

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(a)



rom D713 International Boycott Report OMB No, 1548-0216

Expires 7-31-87
For taxable year beginning
and ending

(Rev. January 1985)
Department of the Treasury

To be Filed
in Duplicate

Internal Revenue Service > Controlled groups, see specific instructions. (See Instruction B)
Name 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 filer (check one):
C1 Individual 1 Partnership © Corporation © Trust O Estate 1 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 identification number in line 4(b) of the corporation whose taxable year is designated.
Taxpayer identifying
Name number

If necessary, attach more sheets andcheckthisbox . . . . . . - eee ee ee > oO
Code Description

(c) Enter principal business activity code and description (see instructions) on
(d) 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-DISC, 1120F, 1120L, 1120M, etc.) Soe —
(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) ©. © 6 6 we ee ee
(2) Taxable income before net operating loss and special deductions (see instructions)

5 Estates or trusts.—Enter total income (Form 1041,pagel). . . ws.
6 Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions):
(a) Foreign tax credit ee

(b) Deferral of earnings of controlled foreign corporations
(c) Deferral of DISC income ee

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

Signature Pee een eee Date m® _____ e222 ------ ee

Title >

For Paperwork Reduction Act Notice, see page 1 of the instructions.


Form 5713 (Rev. 1-85)

Page 2

7 The following information must be submitted by every person filing Form 5713 (see specific instructions):

(a) Are you a United States shareholder (as defined in section 951(b)) of any foreign corporation that had operations
reportable under section 999(a)? . .

(b) If so, is any foreign corporation a controlled foreign co" poration (as defined i in section 957(a)?

(c) Do you own any stock of a DISC?

(d) Do you claim any foreign tax credit?

(e) Do you control (within the meaning of section 304(c)) any ¥ corporation (other than a corporation included i in n this report)
who has operations reportable under section 999(a)?
If “Yes,” did the corporation controlled by you participate in or cooperate with an international boycott ata any '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 z a person included i in this report)
who has operations reportable under section 999(a)? .
If “Yes,” did the person controlling you participate in or cooperate with a an international ‘boycott at any 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 99007
(h) Are you a partner in a partnership that has operations reportable under section g99(a)?__. . .

Yes | No

GEM] (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 or a
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)? rn
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 a DISC, enter the product code. If necessary,
attach additional sheets using the exact format and check this box woe

Yes | No

> 0

Taxpayer identifying number of Pinal business aly

‘Name of country person(s) having operations
Code Description

() (2) @) (4)

Discs
only—Enter
product code

©)

(a)

(b)

(c)

(d)

(e)

@

(e)

(h)

@

@

(k)

0}

(m)

(n)

(0)

(p)



Form 5713 (Rev. 1-85)

Page 3

9 Non-listed countries boycotting Israel.—Did you have operations in any non-listed country which you know or have reason Yes | No
to know requires participation in or cooperation with an international boycott directed against Israel? hone
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 necessary, attach
additional sheets using the exact format and check this box woe . ee : ae |
Taxpayer identifying number of Principat business activity Discs
Name of country ‘person(s) having operations, only—Enter
Code Description product code
@ (2) (3) 4) 5)

(a)

(b)

(c)

()

e)

fy

(e)

(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? . —
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 ec code. If necessary, attach
additional sheets using the exact format and check this box : > Oo

Taxpayer identifying number of Principal business activity DISCs
Name of country person(s) having operations only—Enter
Code Description Product code

(62) (2) (3) (4) (5)

(a)

(b)

(©)

(4)

(e)

fy

(s) -

(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. if 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: /fthe 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).