Form   
8886 
(Rev. March 2011) 
Department of the Treasury  
Internal Revenue Service 
Reportable Transaction Disclosure Statement 
      
Attach to your tax return. 
     
See separate instructions. 
OMB No. 1545-1800 
Attachment 
Sequence No. 
137 
F
F
Name(s) shown on return (individuals enter last name, first name, middle initial) 
Identifying number
Number, street, and room or suite no. 
 City or town
 State
 ZIP code
A 
 
If you are filing more than one Form 8886 with your tax return, sequentially number  
each Form 8886 and enter the statement number for this Form 8886  . . . . . . . . . . . . . . . 
F
Statement number 
of 
B 
Enter the form number of the tax return to which this form is attached or related . . . . . . . . . . . . . . . . . . . . . . .
 . . . .  
F
Enter the year of the tax return identified above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 . . . . . . . . . . . . . .
F
Is this Form 8886 being filed with an amended tax return?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
. . . . . . . . . .
F
Yes
No
C 
Check the box(es) that apply (see instructions). 
Initial year filer 
Protective disclosure 
1a 
Name of reportable transaction 
1 b
Initial year participated in transaction 
1c
Reportable transaction or tax shelter registration number  (see instructions) 
2 
Identify the type of reportable transaction. Check all boxes that apply (see instructions). 
a 
Listed 
b 
Confidential 
c 
Contractual protection 
d 
Loss 
e 
Transaction of interest
3 
If you checked box 2a or 2e, enter the published guidance number for the listed transaction or transaction 
of interest  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
. . . . . . . . . . . 
F
4 
Enter the number of “same as or substantially similar” transactions reported on this form . . . . . . . . . . . . . . . . . . .
 .
F
5 
If you participated in this reportable transaction through a partnership, S corporation, trust, and foreign entity, check the a
pplicable boxes and 
provide the information below for the entity(s) (see instructions). (Attach additional sheets, if necessary.)
a
Type of entity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
F
Partnership 
S corporation 
Trust 
Foreign 
Partnership 
S corporation 
Trust 
Foreign 
b
Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
F
c
Employer identification number (EIN), if known . . . .
F
d 
 
Date Schedule K-1 received from entity  
(enter “none” if Schedule K-1 not received) . . . . . . .
F
6 
 
 
Enter below the name and address of each individual or entity to whom you paid a fee with regard to the transaction if that  in
dividual or entity 
promoted, solicited, or recommended your participation in the transaction, or provided tax advice related to the  transaction. 
(Attach additional 
sheets, if necessary.) 
a 
Name 
Identifying number (if known) 
Fees paid 
$ 
Number, street, and room or suite no. 
City or town
 State
 ZIP code
b 
Name 
Identifying number (if known) 
Fees paid 
$ 
Number, street, and room or suite no. 
City or town
 State
 ZIP code
For Paperwork Reduction Act Notice, see separate instructions. 
Cat. No. 34654G 
Form 
8886
 (Rev. 3-2011) 
----------------Page (0) Break----------------
Form 8886 (Rev. 3-2011) 
Page  
2 
7 Facts 
a 
Identify the type of tax benefit generated by the transaction. Check all the boxes that apply (see instructions). 
Deductions 
Capital loss 
Ordinary loss 
Exclusions from gross income 
Nonrecognition of gain 
Adjustments to basis 
Absence of adjustments to basis
Deferral 
Other
Tax Credits
b 
  
  
 
Further describe the amount and nature of the expected tax treatment and expected tax benefits generated by the transaction for
 all affected 
years. Include facts of each step of the transaction that relate to the expected tax benefits including the amount and nature o
f your investment. 
Include in your description your participation in the transaction and all related transactions regardless of the year in which 
they were entered 
into. Also, include a description of any tax result protection with respect to the transaction. 
8 
 
 
 
Identify all individuals and entities involved in the transaction that are tax-exempt, foreign, or related. Check the appropria
te box(es) (see 
instructions). Include their name(s), identifying number(s), address(es), and a brief description of their involvement. For eac
h foreign entity, 
identify its country of incorporation or existence. For each individual or related entity, explain how the individual or entity
 is related. Attach 
additional sheets, if necessary.
a 
Type of individual or entity: 
Tax-exempt 
Foreign 
Related 
Name 
Identifying number
Address 
Description 
b 
Type of individual or  entity: 
Tax-exempt 
Foreign 
Related 
Name 
Identifying number
Address 
Description 
Form 
8886
 (Rev. 3-2011) 
----------------Page (1) Break----------------