WHO TO CONTACT

For Additional Registrations:

-Call Strafford Customer Service 1-800-926-7926 x10 (or 404-881-1141 x10)

For Assistance During the Program:

-On the web, use the chat box at the bottom left of the screen

If you get disconnected during the program, you can simply log in using your original instructions and PIN.

IMPORTANT INFORMATION

This program is approved for 2 CPE credit hours. To earn credit you must:

• Participate in the program on your own computer connection (no sharing) – if you need to register

additional people, please call customer service at 1-800-926-7926 x10 (or 404-881-1141 x10). Strafford

accepts American Express, Visa, MasterCard, Discover.

• Listen on-line via your computer speakers.

• Respond to five prompts during the program plus a single verification code. You will have to write down

only the final verification code on the attestation form, which will be emailed to registered attendees.

• To earn full credit, you must remain connected for the entire program.

Form 8621 PFIC Reporting: Navigating the Highly

Complex IRS Passive Foreign Investment Company Rules

THURSDAY, JANUARY 7, 2016, 1:00-2:50 pm Eastern

53031104-01-15

A B C D E F G H I J

PFICapplicable dateDate holding period began

Date holding period ended

1.

2.

3.

4.5.

6.7.

8.

Total current year distribution from Form 8621, line 15a

Distribution amount

Apportionment ratio (divide line 2 by line 1)

Excess distribution from Form 8621, lines 15e and 15fExcess distribution apportioned to this distribution (multiplyline 3 by line 4)

Number of days in holding periodAmount of excess distribution allocated to each day in theholding period (divide line 5 by line 6)

Foreign tax credit9.

10.

11.

12.

Gain on disposition of Section 1291 stock from Form 8621,line 15fRatio of excess distributions to total current yeardistributions (divide line 5 by net of line 1 plus line 9)Foreign tax credit allocated to excess distributions(multiply line 8 by line 10)Foreign tax credit allocated to each day in the holdingperiod (divide line 11 by line 6)

Interest charged in tax year

from column A

TaxYear

Days inTaxYear

ExcessDistributionAllocated toEach Day

(from line 7)

ExcessDistributionAllocated toEach Year

(multiply columnB by column C)

Highest MarginalTax Rate

Increase in Tax(multiply

column D bycolumn E)

Foreign Tax CreditAllocated to

Each Day(from line 12)

Foreign Tax CreditAllocated toEach Year

(multiply columnB by column G)

Additional Tax(subtract columnH from column F)

Interest onIncrease in Tax

Additional Tax and Interest Calculation

Form 8621 Increase in Tax and Interest Calculations

L

01/01/2012 01/01/2012 Europe Index Mutual Fund12/31/2015

20,000.0020,000.00

1.00000007,500.00

7,500.001461

5.1334702

2012 366 5.1334702 1,879.00 .350000000 658.00 658.00 14.21

2013 365 5.1334702 1,874.00 .396000000 742.00 742.00 36.442014 365 5.1334702 1,874.00 .396000000 742.00 742.00 60.08

* 2015 20.09** 2015 365 5.1334702 1,874.00

* Interest on Prior Year(s) Additional Tax** Excess Distribution Allocated to Current Tax Year or Pre-PFIC Year

, 20

(4) if childunder age 17

qualifying for childtax credit

(99)

IRS Use Only - Do not write or staple in this space.OMB No. 1545-0074

For the year Jan. 1-Dec. 31, 2015, or other tax year beginning , 2015, ending

Your social security number

Spouse's social security number

Make sure the SSN(s) above

and on line 6c are correct.

Presidential Election CampaignCity, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.Check here if you, or your spouseif filing jointly, want $3 to go tothis fund. Checking a box belowwill not change your tax or refund.

Boxes checked on 6a and 6b

No. of childrenon 6c who:

(3) Dependent'srelationship to

you

(2) Dependent's socialsecurity number

lived with you

did not live withyou due to divorceor separation(see instructions)

(1) First name Last name

Dependents on 6cnot entered above

Add numberson linesabove

Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ

51000107-30-15

Form (2015)

See separate instructions.

1

2

3

4

5

6a

b

Yourself.

Spouse

do not

c Dependents:

d

7 7

8a8a

b

Taxable

8bTax-exempt Do notAttach Form(s) W-2 here. Alsoattach Forms W-2G and1099-R if taxwas withheld.

9a9a

b 9b

10

11

12

13

14

15a

16a

17

18

19

20a

21

10

11

12

13

14

15b

16b

15a

16a

b

b

17

18

19

20b20a b

21

2222 total income

23

24

25

26

27

28

29

30

23

24

25

26

27

28

29

30

31a

32

33

34

35

31a

32

b

33

34

35

36

37

36

37adjusted gross income

1040

You Spouse

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Form

Your first name and initial Last name

If a joint return, spouse's first name and initial Last name

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

Foreign country name Foreign province/state/county Foreign postal code

Single

Married filing jointly (even if only one had income)

Married filing separately. Enter spouse's SSN above

and full name here.

Head of household (with qualifying person). If the qualifying

person is a child but not your dependent, enter this child's

name here.Check onlyone box. Qualifying widow(er) with dependent child

If someone can claim you as a dependent, check box 6a ~~~~~~~~~~~~~~~~

���������������������������������������������

If more than fourdependents, seeinstructions andcheck here

Total number of exemptions claimed������������������������������������

Wages, salaries, tips, etc. Attach Form(s) W-2 ~~~~~~~~~~~~~~~~~~~~~~~~~~

interest. Attach Schedule B if required ~~~~~~~~~~~~~~~~~~~~~~~~~~

interest. include on line 8a ~~~~~~~~~~~

Ordinary dividends. Attach Schedule B if required ~~~~~~~~~~~~~~~~~~~~~~~~~

Qualified dividends ~~~~~~~~~~~~~~~~~~~~~~~

Taxable refunds, credits, or offsets of state and local income taxes~~~~~~~~~~~~~~~~~~

Alimony received

Business income or (loss). Attach Schedule C or C-EZ

Capital gain or (loss). Attach Schedule D if required. If not required, check here

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~ |If you did notget a W-2,see instructions.

Other gains or (losses). Attach Form 4797 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

IRA distributions

Pensions and annuities

~~~~~~~ Taxable amount

Taxable amount

~~~~~~

~~~~ ~~~~~~

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

Farm income or (loss). Attach Schedule F

~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Unemployment compensation ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Social security benefits ~~~~ Taxable amount ~~~~~~

Other income. List type and amount

Combine the amounts in the far right column for lines 7 through 21. This is your ��� |

~~~~~~~~~~~~~~~~~~~~~~~~~~~Reserved

~~~~~~~~~~~~~~~~~

Health savings account deduction. Attach Form 8889 ~~~~~~~~

Moving expenses. Attach Form 3903 ~~~~~~~~~~~~~~~

Deductible part of self-employment tax. Attach Schedule SE~~~~~~

Self-employed SEP, SIMPLE, and qualified plans ~~~~~~~~~~

Self-employed health insurance deduction ~~~~~~~~~~~~~

Penalty on early withdrawal of savings ~~~~~~~~~~~~~~~

Alimony paid Recipient's SSN |

IRA deduction

Student loan interest deduction

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~

Reserved ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Domestic production activities deduction. Attach Form 8903 ~~~~~

Add lines 23 through 35 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��������������� |Subtract line 36 from line 22. This is your

|

|

LHA

U.S. Individual Income Tax Return

Filing Status

Exemptions

Income

AdjustedGrossIncome

1040 2015

      

 

   

u

 

 

" "" "

;

9pmoBB

9

! !

P

John Smith Applied For

1060 West Addison St.

Chicago, IL 90210

X

X 1

1

12,500.

See Statement 1 1,874.14,374.

14,374.

Reserved

Routingnumber

AccountnumberType: Checking Savings

Designee's Phoneno.

Form 1040 (2015) Page

StandardDeduction for -

People whocheck any boxon line 39a or39b who canbe claimed as adependent, seeinstructions.

All others:Single orMarried filingseparately,$6,300

Married filingjointly orQualifyingwidow(er),$12,600

Head ofhousehold,$9,250

If you have a

qualifyingchild, attach

Schedule EIC.

Direct deposit?See instructions.

namePersonal identificationnumber (PIN)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Daytime phone numberYour signature Date Your occupation

Joint return?See instructions.Keep a copyfor yourrecords.

Spouse's occupationDateSpouse's signature. If a joint return, must sign. If the IRS sent you an IdentityProtection PIN,enter it here

Check

self-employed

if PTINPrint/Type preparer's name Preparer's signature Date

Firm's name Firm's EIN

Phone no.51000207-30-15 Firm's address

both

2

38 38

39a You Total boxes

checked 39aSpouse

39bb

or40

41

42

43

44

45

46

Itemized deductions or standard deduction 40

41

42

43

44

45

46

47

Exemptions.

Taxable income.

cTax. a b

Alternative minimum tax.

47

48

49

50

51

52

48

49

50

51

52

53

54

53

54

55

56

57

58

59

60a

b

61

62

63

b ca

total credits 55

56

57

58a b

59

60a

60b

61

62

63

b ca

total tax

64

65

66

67

68

69

70

71

72

73

74

64

65

66a

67

68

69

70

71

72

73

a

b

Earned income credit (EIC)

66b

a b c d

total payments 74

75

76a

75 overpaid

76

a

b

refunded to you.

c d

77

78

79

applied to your 2016 estimated tax 77

Amount you owe. 78

79

Yes. No

Amount from line 37 (adjusted gross income) �����������������������������

Check

if:

were born before January 2, 1951, Blind.

was born before January 2, 1951, Blind. ~

If your spouse itemizes on a separate return or you were a dual-status alien, check here¥ ~~

(from Schedule A) your (see left margin) ~~~~~~~~~~~

Subtract line 40 from line 38 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see inst. ~~

Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- ~~~~~~~~~~~

Check if any from: Form(s) 8814 Form 4972 ~~~~~

Attach Form 6251 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~¥ Excess advance premium tax credit repayment. Attach Form 8962 ~~~~~~~~~~~~~~~~~~~~

Add lines 44, 45, and 46 ������������������������������������ |

Foreign tax credit. Attach Form 1116 if required ~~~~~~~~~~~~~

Credit for child and dependent care expenses. Attach Form 2441 ~~~~~~

Education credits from Form 8863, line 19 ~~~~~~~~~~~~~~~

Retirement savings contributions credit. Attach Form 8880 ~~~~~~~~

Child tax credit. Attach Schedule 8812, if required ~~~~~~~~~~~~

Residential energy credit. Attach Form 5695 ~~~~~~~~~~~~~~

Other credits from Form: 3800 8801

Add lines 48 through 54. These are your ~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- ����������������� |

Self-employment tax. Attach Schedule SE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

4137 8919 ~~~~~~~~~~~Unreported social security and Medicare tax from Form:

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ~~~~~~~~~~

Household employment taxes from Schedule H

First-time homebuyer credit repayment. Attach Form 5405 if required

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~

Health care: Individual responsibility (see instructions) Full-year coverage ~~~~~~~~~~~

Form 8959 Form 8960Taxes from: Inst.; enter code(s)

Add lines 56 through 62. This is your ��������������������������� |

Federal income tax withheld from Forms W-2 and 1099 ~~~~~~~~~~

2015 estimated tax payments and amount applied from 2014 return ~~~~

����������������������

Nontaxable combat pay election ~~~~~

Additional child tax credit. Attach Schedule 8812 ~~~~~~~~~~~~

American opportunity credit from Form 8863, line 8 ~~~~~~~~~~~

Net premium tax credit. Attach Form 8962 ~~~~~~~~~~~~~~~

Amount paid with request for extension to file ~~~~~~~~~~~~~~

Excess social security and tier 1 RRTA tax withheld

Credit for federal tax on fuels. Attach Form 4136

~~~~~~~~~~~

~~~~~~~~~~~~~

Credits from Form: 2439 8885

Add lines 64, 65, 66a, and 67 through 73. These are your ������������� |

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you ~~~~~~~~~|��������Amount of line 75 you want If Form 8888 is attached, check here

| | |

Amount of line 75 you want ���

Subtract line 74 from line 63. For details on how to pay, see instructions ~~~~~~~ |

Estimated tax penalty (see instructions) ����������������

Do you want to allow another person to discuss this return with the IRS (see instructions)? Complete below.

| | |

Tax andCredits

OtherTaxes

Payments

Refund

AmountYou OweThird PartyDesignee

SignHere

PaidPreparerUse Only

      

 

    

     

   

      

       

    

   

 

rqs pmo 99

9

=

9 9 "9

P

Statement 2

John Smith Applied For14,374.

6,300.8,074.4,000.4,074.

X 1291 TAX 2,550.

2,550.

2,550.

XX 131.

2,681.

2,727.46.

Form

(Rev. December 2014)

OMB No. 1545-1002

AttachmentSequence No.

Department of the TreasuryInternal Revenue Service

Shareholder tax year: calendar year or other tax year beginning

, and ending , .

51261104-01-15

69| Information about Form 8621 and its separate instructions is at .

Identifying number

Employer identification number

Reference ID number

1

2

3

4

5

(a)

(e)

(b) (c) (d)

(a)

(b)

(c)

Election To Treat the PFIC as a QEF.

Election To Extend Time For Payment of Tax.

Note:

Election To Mark-to-Market PFIC Stock.

Deemed Sale Election.

Deemed Dividend Election.

Election To Recognize Gain on Deemed Sale of PFIC.

Deemed Dividend Election With Respect to a Section 1297(e) PFIC.

Deemed Dividend Election With Respect to a Former PFIC.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 8621

Complete lines 6a through 7c of Part III.

Complete lines 8a through 9c of Part III to calculate the tax that may be deferred.If any portion of line 6a or line 7a of Part III is includible under section 951, you may make this election. Also, see sections

1294(c) and 1294(f) and the related regulations for events that terminate this election.

Complete Part IV.

Enter gain or loss on line 15f of Part V.

Enter this amount on line 15e of Part V. If theexcess distribution is greater than zero, also complete line 16 of Part V.

Entergain on line 15f of Part V.

Enter the excess distribution on line 15e, Part V. If the excessdistribution is greater than zero, also complete line 16, Part V.

Enter the excess distribution on line 15e, Part V. If the excess distribution is greater than zero, alsocomplete line 16, Part V.

(see instructions)Name of shareholder

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

City or town, state, and ZIP code or country

Check type of shareholder filing the return: Individual Corporation Partnership S Corporation Nongrantor Trust Estate

Name of passive foreign investment company (PFIC) or qualified electing fund (QEF) (if any)

Address (Enter number, street, city or town, and country.) (see instructions)

Tax year of PFIC or QEF: calendar year or other

tax year beginning , and

ending , .

Provide the following information with respect to all shares of the PFIC held by the shareholder:

Description of each class of shares held by the shareholder:

Check if shares jointly owned with spouse.

Date shares acquired during the taxable year, if applicable:

Number of shares held at the end of the taxable year:

Value of shares held at the end of the taxable year (check the appropriate box, if applicable):

$0-50,000 $50,001-100,000 $100,001-150,000 $150,001-200,000

If more than $200,000, list value:

Type of PFIC and amount of any excess distribution or gain treated as an excess distribution under section 1291, inclusion under section

1293, or inclusion or deduction under section 1296:

Section 1291

Section 1293 (Qualified Electing Fund)

Section 1296 (Mark to Market)

$

$

$

I, a shareholder of a PFIC, elect to treat the PFIC as a QEF.

I, a shareholder of a QEF, elect to extend the time for payment of tax on the undistributed earnings and profitsof the QEF until this election is terminated.

I, a shareholder of a PFIC, elect to mark-to-market the PFIC stock that is marketable within the meaning of section1296(e).

I, a shareholder on the first day of a PFIC's first tax year as a QEF, elect to recognize gain on the deemed sale of my interest in thePFIC.

I, a shareholder on the first day of a PFIC's first tax year as a QEF that is a controlled foreign corporation (CFC), elect to treat anamount equal to my share of the post-1986 earnings and profits of the CFC as an excess distribution.

I, a shareholder of a former PFIC or a PFIC to which section 1297(d) applies, elect to treat as an excessdistribution the gain recognized on the deemed sale of my interest in the PFIC on the last day of its last tax year as a PFIC under section 1297(a).

I, a shareholder of a section 1297(e) PFIC, within the meaning of Regulations section1.1297-3(a), elect to make a deemed dividend election with respect to the Section 1297(e) PFIC. My holding period in the stock of the Section 1297(e)PFIC includes the CFC qualification date, as defined in Regulations section 1.1297-3(d).

I, a shareholder of a former PFIC, within the meaning of Regulations section 1.1298-3(a),elect to make a deemed dividend election with respect to the former PFIC. My holding period in the stock of the former PFIC includes the termination date, asdefined in Regulations section 1.1298-3(d).

Form (Rev. 12-2014)LHA

www.irs.gov/form8621

not

Part I Summary of Annual Information

Part II Elections AB

C

D

E

F

G

H

(See instructions.)

(See instructions.)

Information Return by a Shareholder of a Passive ForeignInvestment Company or Qualified Electing Fund

8621

           

 

       

   

  

 

 

 

 

 

 

John Smith Applied For2015

1060 West Addison St.

Chicago, IL 90210X

Europe Index Mutual Fund

2015221B Baker StreetLondon 00000 United Kingdom

B

500.

500,000.

X 7,500.

14271229 794837 PFIC 2015.01000 Smith, John PFIC1 14

51261204-01-15

2

6

7

8

9

a

b

c

6a

6b

7a

7b

6c

7c

8a

8d

8e

9c

a

b

c

a

b

c

d

e

8b

8c

Important:

9a

9b

a

b

c This is the deferred tax, the time for payment of which is extended by making

Election B

10

11

12

13

14

a

b

c

10a

10b

10c

11

12

13a

13b

13c

14a

14b

14c

If you sold or otherwise disposed of any section 1296 stock (see instructions) during the tax year:

a

b

c

a

b

c

Note.

8621

If line 8e is greater than zero, and no portion of line 6a or 7a is includible in income under section 951,you may make Election B with respect to the amount on line 8e.

Form 8621 (Rev. 12-2014) Page

All QEF shareholders complete lines 6a through 7c. If you are makingElection B, also complete lines 8a through 9c. (See instructions.)

Enter your pro rata share of the ordinary earnings of the QEF ~~~~~~~~~~~~

Enter the portion of line 6a that is included in income under section 951 or that may be

excluded under section 1293(g) ~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 6b from line 6a. Enter this amount on your tax return as ordinary income �����������������

Enter your pro rata share of the total net capital gain of the QEF ~~~~~~~~~~~

Enter the portion of line 7a that is included in income under section 951 or that may be

excluded under section 1293(g) ~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 7b from line 7a. This amount is a net long-term capital gain. Enter this amount in Part II of the Schedule D

used for your income tax return. (See instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines 6c and 7c ����������������������������������������������

Enter the total amount of cash and the fair market value of other property distributed

or deemed distributed to you during the tax year of the QEF. (See instructions.) ~~~~

Enter the portion of line 8a not already included in line 8b that is attributable to shares

in the QEF that you disposed of, pledged, or otherwise transferred during the tax year ~

Add lines 8b and 8c ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 8d from line 8a, and enter the difference (if zero or less, enter amount in brackets) ~~~~~~~~~~~~~

Enter the total tax for the tax year (See instructions.) ~~~~~~~~~~~~~~~~

Enter the total tax for the tax year determined without regard to the amount entered

on line 8e ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 9b from line 9a.

��������������������������������������������������

Enter the fair market value of your PFIC stock at the end of the tax year

Enter your adjusted basis in the stock at the end of the tax year

Subtract line 10b from line 10a. If a gain, do not complete lines 11 and 12. Include this amount as ordinary income

on your tax return. If a loss, go to line 11

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter any unreversed inclusions (as defined in section 1296(d)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the loss from line 10c, but only to the extent of unreversed inclusions on line 11. Include this amount as an ordinary

loss on your tax return ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the fair market value of the stock on the date of sale or disposition

Enter the adjusted basis of the stock on the date of sale or disposition

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 13b from line 13a. If a gain, do not complete line 14. Include this amount as ordinary income on your

tax return. If a loss, go to line 14 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter any unreversed inclusions (as defined in section 1296(d)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the loss from line 13c, but only to the extent of unreversed inclusions on line 14a. Include this amount as an ordinary

loss on your tax return. If the loss on line 13c exceeds unreversed inclusions on line 14a, complete line 14c ~~~~~~~~

Enter the amount by which the loss on line 13c exceeds unreversed inclusions on line 14a. Include this amount on your tax

return according to the rules generally applicable for losses provided elsewhere in the Code and regulations ~~~~~~~

See instructions in case of multiple sales or dispositions.

Form (Rev. 12-2014)

Part III Income From a Qualified Electing Fund (QEF).

Part IV Gain or (Loss) From Mark-to-Market Election (See instructions.)

14271229 794837 PFIC 2015.01000 Smith, John PFIC1 15

Interest accrued on deferred

tax (line 19) as of the filing date

Earnings distributed or deemed

distributed during the tax year

Deferred tax outstanding after

partial termination of election

51261304-01-15

3

15

16

a

b

c

d

e

f

a

b

c

d

e

f

15a

15b

15c

15d

15e

15f

16b

16c

16d

16e

16f

do not

do not

(i) (ii) (iii) (iv) (v) (vi)

17

18

19

20

21

22

23

24

25

26

8621

Complete a Part V for each excess distribution and disposition (see instructions).

Complete a separate column for each outstanding election. Complete lines 25 and 26 only if there is a partial termination of the section1294 election.

Form 8621 (Rev. 12-2014) Page

Enter your total distributions from the section 1291 fund during the current tax year with respect to the applicable stock. If the

holding period of the stock began in the current tax year, see instructions

Enter the total distributions (reduced by the portions of such distributions that were excess distributions but not

included in income under section 1291(a)(1)(B)) made by the fund with respect to the applicable stock for each of the 3 years

preceding the current tax year (or if shorter, the portion of the shareholder's holding period before the current tax year)

Divide line 15b by 3. (See instructions if the number of preceding tax years is less than 3.) ~~~~~~~~~~~~~~~

Multiply line 15c by 125% (1.25)

Subtract line 15d from line 15a. This amount, if more than zero, is the excess distribution with respect to the applicable stock.

If there is an excess distribution, complete line 16. If zero or less and you did not dispose of stock during the tax year,

complete the rest of Part V. See instructions if you received more than one distribution during the current tax year. Also,

see instructions for rules for reporting a nonexcess distribution on your income tax return ~~~~~~~~~~~~~~~

Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund. If a gain,

complete line 16. If a loss, show it in brackets and complete line 16

If there is a positive amount on line 15e or 15f (or both), attach a statement for each excess distribution and disposition.

Show your holding period for each share of stock or block of shares held. Allocate the excess distribution or gain to each day

in your holding period. Add all amounts that are allocated to days in each tax year.

Enter the total of the amounts determined in line 16a that are allocable to the current tax year and tax years

before the foreign corporation became a PFIC (pre-PFIC years). Enter these amounts on your income tax

return as other income

Enter the aggregate increases in tax (before credits) for each tax year in your holding period

(other than the current tax year and pre-PFIC years). (See instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~

Foreign tax credit. (See instructions.)

Subtract line 16d from line 16c. Enter this amount on your income tax return as "additional tax." (See instructions.)

Determine interest on each net increase in tax determined on line 16e using the rates and methods of section 6621.

Enter the aggregate amount of interest here. (See instructions.)����������������������������

Tax year of outstanding

election

Undistributed earnings to

which the election relates

Deferred tax

Event terminating election

Deferred tax due with this

return

Accrued interest due with

this return

Interest accrued after partial

termination of election ��

Form (Rev. 12-2014)

~~~~~~~~~~~~~~~~~~~~~~~

~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~

~~~~~~~~

~~~~~~

~~~~~~~~~

~~~~~~~

~

separate

Distributions From and Dispositions of Stock of a Section 1291 Fund

Part V

Part VI Status of Prior Year Section 1294 Elections and Termination of Section 1294 Elections

(See instructions.)

20,000.

30,000.10,000.12,500.

7,500.

1,874.

2,142.

2,142.

131.

14271229 794837 PFIC 2015.01000 Smith, John PFIC1 16

, 20

(4) if childunder age 17

qualifying for childtax credit

(99)

IRS Use Only - Do not write or staple in this space.OMB No. 1545-0074

For the year Jan. 1-Dec. 31, 2015, or other tax year beginning , 2015, ending

Your social security number

Spouse's social security number

Make sure the SSN(s) above

and on line 6c are correct.

Presidential Election CampaignCity, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.Check here if you, or your spouseif filing jointly, want $3 to go tothis fund. Checking a box belowwill not change your tax or refund.

Boxes checked on 6a and 6b

No. of childrenon 6c who:

(3) Dependent'srelationship to

you

(2) Dependent's socialsecurity number

lived with you

did not live withyou due to divorceor separation(see instructions)

(1) First name Last name

Dependents on 6cnot entered above

Add numberson linesabove

Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ

51000107-30-15

Form (2015)

See separate instructions.

1

2

3

4

5

6a

b

Yourself.

Spouse

do not

c Dependents:

d

7 7

8a8a

b

Taxable

8bTax-exempt Do notAttach Form(s) W-2 here. Alsoattach Forms W-2G and1099-R if taxwas withheld.

9a9a

b 9b

10

11

12

13

14

15a

16a

17

18

19

20a

21

10

11

12

13

14

15b

16b

15a

16a

b

b

17

18

19

20b20a b

21

2222 total income

23

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29

30

23

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28

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30

31a

32

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35

31a

32

b

33

34

35

36

37

36

37adjusted gross income

1040

You Spouse

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.

Form

Your first name and initial Last name

If a joint return, spouse's first name and initial Last name

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

Foreign country name Foreign province/state/county Foreign postal code

Single

Married filing jointly (even if only one had income)

Married filing separately. Enter spouse's SSN above

and full name here.

Head of household (with qualifying person). If the qualifying

person is a child but not your dependent, enter this child's

name here.Check onlyone box. Qualifying widow(er) with dependent child

If someone can claim you as a dependent, check box 6a ~~~~~~~~~~~~~~~~

���������������������������������������������

If more than fourdependents, seeinstructions andcheck here

Total number of exemptions claimed������������������������������������

Wages, salaries, tips, etc. Attach Form(s) W-2 ~~~~~~~~~~~~~~~~~~~~~~~~~~

interest. Attach Schedule B if required ~~~~~~~~~~~~~~~~~~~~~~~~~~

interest. include on line 8a ~~~~~~~~~~~

Ordinary dividends. Attach Schedule B if required ~~~~~~~~~~~~~~~~~~~~~~~~~

Qualified dividends ~~~~~~~~~~~~~~~~~~~~~~~

Taxable refunds, credits, or offsets of state and local income taxes~~~~~~~~~~~~~~~~~~

Alimony received

Business income or (loss). Attach Schedule C or C-EZ

Capital gain or (loss). Attach Schedule D if required. If not required, check here

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~ |If you did notget a W-2,see instructions.

Other gains or (losses). Attach Form 4797 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

IRA distributions

Pensions and annuities

~~~~~~~ Taxable amount

Taxable amount

~~~~~~

~~~~ ~~~~~~

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E

Farm income or (loss). Attach Schedule F

~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Unemployment compensation ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Social security benefits ~~~~ Taxable amount ~~~~~~

Other income. List type and amount

Combine the amounts in the far right column for lines 7 through 21. This is your ��� |

~~~~~~~~~~~~~~~~~~~~~~~~~~~Reserved

~~~~~~~~~~~~~~~~~

Health savings account deduction. Attach Form 8889 ~~~~~~~~

Moving expenses. Attach Form 3903 ~~~~~~~~~~~~~~~

Deductible part of self-employment tax. Attach Schedule SE~~~~~~

Self-employed SEP, SIMPLE, and qualified plans ~~~~~~~~~~

Self-employed health insurance deduction ~~~~~~~~~~~~~

Penalty on early withdrawal of savings ~~~~~~~~~~~~~~~

Alimony paid Recipient's SSN |

IRA deduction

Student loan interest deduction

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~

Reserved ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Domestic production activities deduction. Attach Form 8903 ~~~~~

Add lines 23 through 35 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��������������� |Subtract line 36 from line 22. This is your

|

|

LHA

U.S. Individual Income Tax Return

Filing Status

Exemptions

Income

AdjustedGrossIncome

1040 2015

      

 

   

u

 

 

" "" "

;

9pmoBB

9

! !

P

John Smith Applied For

1060 West Addison St.

Chicago, IL 90210

X

X 1

1

20,000.

See Statement 1 10,000.30,000.

30,000.

Reserved

Routingnumber

AccountnumberType: Checking Savings

Designee's Phoneno.

Form 1040 (2015) Page

StandardDeduction for -

People whocheck any boxon line 39a or39b who canbe claimed as adependent, seeinstructions.

All others:Single orMarried filingseparately,$6,300

Married filingjointly orQualifyingwidow(er),$12,600

Head ofhousehold,$9,250

If you have a

qualifyingchild, attach

Schedule EIC.

Direct deposit?See instructions.

namePersonal identificationnumber (PIN)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Daytime phone numberYour signature Date Your occupation

Joint return?See instructions.Keep a copyfor yourrecords.

Spouse's occupationDateSpouse's signature. If a joint return, must sign. If the IRS sent you an IdentityProtection PIN,enter it here

Check

self-employed

if PTINPrint/Type preparer's name Preparer's signature Date

Firm's name Firm's EIN

Phone no.51000207-30-15 Firm's address

both

2

38 38

39a You Total boxes

checked 39aSpouse

39bb

or40

41

42

43

44

45

46

Itemized deductions or standard deduction 40

41

42

43

44

45

46

47

Exemptions.

Taxable income.

cTax. a b

Alternative minimum tax.

47

48

49

50

51

52

48

49

50

51

52

53

54

53

54

55

56

57

58

59

60a

b

61

62

63

b ca

total credits 55

56

57

58a b

59

60a

60b

61

62

63

b ca

total tax

64

65

66

67

68

69

70

71

72

73

74

64

65

66a

67

68

69

70

71

72

73

a

b

Earned income credit (EIC)

66b

a b c d

total payments 74

75

76a

75 overpaid

76

a

b

refunded to you.

c d

77

78

79

applied to your 2016 estimated tax 77

Amount you owe. 78

79

Yes. No

Amount from line 37 (adjusted gross income) �����������������������������

Check

if:

were born before January 2, 1951, Blind.

was born before January 2, 1951, Blind. ~

If your spouse itemizes on a separate return or you were a dual-status alien, check here¥ ~~

(from Schedule A) your (see left margin) ~~~~~~~~~~~

Subtract line 40 from line 38 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If line 38 is $154,950 or less, multiply $4,000 by the number on line 6d. Otherwise, see inst. ~~

Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- ~~~~~~~~~~~

Check if any from: Form(s) 8814 Form 4972 ~~~~~

Attach Form 6251 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~¥ Excess advance premium tax credit repayment. Attach Form 8962 ~~~~~~~~~~~~~~~~~~~~

Add lines 44, 45, and 46 ������������������������������������ |

Foreign tax credit. Attach Form 1116 if required ~~~~~~~~~~~~~

Credit for child and dependent care expenses. Attach Form 2441 ~~~~~~

Education credits from Form 8863, line 19 ~~~~~~~~~~~~~~~

Retirement savings contributions credit. Attach Form 8880 ~~~~~~~~

Child tax credit. Attach Schedule 8812, if required ~~~~~~~~~~~~

Residential energy credit. Attach Form 5695 ~~~~~~~~~~~~~~

Other credits from Form: 3800 8801

Add lines 48 through 54. These are your ~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- ����������������� |

Self-employment tax. Attach Schedule SE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

4137 8919 ~~~~~~~~~~~Unreported social security and Medicare tax from Form:

Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ~~~~~~~~~~

Household employment taxes from Schedule H

First-time homebuyer credit repayment. Attach Form 5405 if required

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~

Health care: Individual responsibility (see instructions) Full-year coverage ~~~~~~~~~~~

Form 8959 Form 8960Taxes from: Inst.; enter code(s)

Add lines 56 through 62. This is your ��������������������������� |

Federal income tax withheld from Forms W-2 and 1099 ~~~~~~~~~~

2015 estimated tax payments and amount applied from 2014 return ~~~~

����������������������

Nontaxable combat pay election ~~~~~

Additional child tax credit. Attach Schedule 8812 ~~~~~~~~~~~~

American opportunity credit from Form 8863, line 8 ~~~~~~~~~~~

Net premium tax credit. Attach Form 8962 ~~~~~~~~~~~~~~~

Amount paid with request for extension to file ~~~~~~~~~~~~~~

Excess social security and tier 1 RRTA tax withheld

Credit for federal tax on fuels. Attach Form 4136

~~~~~~~~~~~

~~~~~~~~~~~~~

Credits from Form: 2439 8885

Add lines 64, 65, 66a, and 67 through 73. These are your ������������� |

If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you ~~~~~~~~~|��������Amount of line 75 you want If Form 8888 is attached, check here

| | |

Amount of line 75 you want ���

Subtract line 74 from line 63. For details on how to pay, see instructions ~~~~~~~ |

Estimated tax penalty (see instructions) ����������������

Do you want to allow another person to discuss this return with the IRS (see instructions)? Complete below.

| | |

Tax andCredits

OtherTaxes

Payments

Refund

AmountYou OweThird PartyDesignee

SignHere

PaidPreparerUse Only

      

 

    

     

   

      

       

    

   

 

rqs pmo 99

9

=

9 9 "9

P

John Smith Applied For30,000.

6,300.23,700.4,000.

19,700.2,498.

2,498.

2,498.

X

2,498.

2,543.45.

Form

(Rev. December 2014)

OMB No. 1545-1002

AttachmentSequence No.

Department of the TreasuryInternal Revenue Service

Shareholder tax year: calendar year or other tax year beginning

, and ending , .

51261104-01-15

69| Information about Form 8621 and its separate instructions is at .

Identifying number

Employer identification number

Reference ID number

1

2

3

4

5

(a)

(e)

(b) (c) (d)

(a)

(b)

(c)

Election To Treat the PFIC as a QEF.

Election To Extend Time For Payment of Tax.

Note:

Election To Mark-to-Market PFIC Stock.

Deemed Sale Election.

Deemed Dividend Election.

Election To Recognize Gain on Deemed Sale of PFIC.

Deemed Dividend Election With Respect to a Section 1297(e) PFIC.

Deemed Dividend Election With Respect to a Former PFIC.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. 8621

Complete lines 6a through 7c of Part III.

Complete lines 8a through 9c of Part III to calculate the tax that may be deferred.If any portion of line 6a or line 7a of Part III is includible under section 951, you may make this election. Also, see sections

1294(c) and 1294(f) and the related regulations for events that terminate this election.

Complete Part IV.

Enter gain or loss on line 15f of Part V.

Enter this amount on line 15e of Part V. If theexcess distribution is greater than zero, also complete line 16 of Part V.

Entergain on line 15f of Part V.

Enter the excess distribution on line 15e, Part V. If the excessdistribution is greater than zero, also complete line 16, Part V.

Enter the excess distribution on line 15e, Part V. If the excess distribution is greater than zero, alsocomplete line 16, Part V.

(see instructions)Name of shareholder

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

City or town, state, and ZIP code or country

Check type of shareholder filing the return: Individual Corporation Partnership S Corporation Nongrantor Trust Estate

Name of passive foreign investment company (PFIC) or qualified electing fund (QEF) (if any)

Address (Enter number, street, city or town, and country.) (see instructions)

Tax year of PFIC or QEF: calendar year or other

tax year beginning , and

ending , .

Provide the following information with respect to all shares of the PFIC held by the shareholder:

Description of each class of shares held by the shareholder:

Check if shares jointly owned with spouse.

Date shares acquired during the taxable year, if applicable:

Number of shares held at the end of the taxable year:

Value of shares held at the end of the taxable year (check the appropriate box, if applicable):

$0-50,000 $50,001-100,000 $100,001-150,000 $150,001-200,000

If more than $200,000, list value:

Type of PFIC and amount of any excess distribution or gain treated as an excess distribution under section 1291, inclusion under section

1293, or inclusion or deduction under section 1296:

Section 1291

Section 1293 (Qualified Electing Fund)

Section 1296 (Mark to Market)

$

$

$

I, a shareholder of a PFIC, elect to treat the PFIC as a QEF.

I, a shareholder of a QEF, elect to extend the time for payment of tax on the undistributed earnings and profitsof the QEF until this election is terminated.

I, a shareholder of a PFIC, elect to mark-to-market the PFIC stock that is marketable within the meaning of section1296(e).

I, a shareholder on the first day of a PFIC's first tax year as a QEF, elect to recognize gain on the deemed sale of my interest in thePFIC.

I, a shareholder on the first day of a PFIC's first tax year as a QEF that is a controlled foreign corporation (CFC), elect to treat anamount equal to my share of the post-1986 earnings and profits of the CFC as an excess distribution.

I, a shareholder of a former PFIC or a PFIC to which section 1297(d) applies, elect to treat as an excessdistribution the gain recognized on the deemed sale of my interest in the PFIC on the last day of its last tax year as a PFIC under section 1297(a).

I, a shareholder of a section 1297(e) PFIC, within the meaning of Regulations section1.1297-3(a), elect to make a deemed dividend election with respect to the Section 1297(e) PFIC. My holding period in the stock of the Section 1297(e)PFIC includes the CFC qualification date, as defined in Regulations section 1.1297-3(d).

I, a shareholder of a former PFIC, within the meaning of Regulations section 1.1298-3(a),elect to make a deemed dividend election with respect to the former PFIC. My holding period in the stock of the former PFIC includes the termination date, asdefined in Regulations section 1.1298-3(d).

Form (Rev. 12-2014)LHA

www.irs.gov/form8621

not

Part I Summary of Annual Information

Part II Elections AB

C

D

E

F

G

H

(See instructions.)

(See instructions.)

Information Return by a Shareholder of a Passive ForeignInvestment Company or Qualified Electing Fund

8621

           

 

       

   

  

 

 

 

 

 

 

John Smith Applied For2015

1060 West Addison St.

Chicago, IL 90210X

Europe Index Mutual Fund

2015221B Baker StreetLondon 00000 United Kingdom

B

500.

530,000.

X 10,000.

X

17451229 794837 PFIC 2015.01000 Smith, John PFIC2 10

51261204-01-15

2

6

7

8

9

a

b

c

6a

6b

7a

7b

6c

7c

8a

8d

8e

9c

a

b

c

a

b

c

d

e

8b

8c

Important:

9a

9b

a

b

c This is the deferred tax, the time for payment of which is extended by making

Election B

10

11

12

13

14

a

b

c

10a

10b

10c

11

12

13a

13b

13c

14a

14b

14c

If you sold or otherwise disposed of any section 1296 stock (see instructions) during the tax year:

a

b

c

a

b

c

Note.

8621

If line 8e is greater than zero, and no portion of line 6a or 7a is includible in income under section 951,you may make Election B with respect to the amount on line 8e.

Form 8621 (Rev. 12-2014) Page

All QEF shareholders complete lines 6a through 7c. If you are makingElection B, also complete lines 8a through 9c. (See instructions.)

Enter your pro rata share of the ordinary earnings of the QEF ~~~~~~~~~~~~

Enter the portion of line 6a that is included in income under section 951 or that may be

excluded under section 1293(g) ~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 6b from line 6a. Enter this amount on your tax return as ordinary income �����������������

Enter your pro rata share of the total net capital gain of the QEF ~~~~~~~~~~~

Enter the portion of line 7a that is included in income under section 951 or that may be

excluded under section 1293(g) ~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 7b from line 7a. This amount is a net long-term capital gain. Enter this amount in Part II of the Schedule D

used for your income tax return. (See instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines 6c and 7c ����������������������������������������������

Enter the total amount of cash and the fair market value of other property distributed

or deemed distributed to you during the tax year of the QEF. (See instructions.) ~~~~

Enter the portion of line 8a not already included in line 8b that is attributable to shares

in the QEF that you disposed of, pledged, or otherwise transferred during the tax year ~

Add lines 8b and 8c ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 8d from line 8a, and enter the difference (if zero or less, enter amount in brackets) ~~~~~~~~~~~~~

Enter the total tax for the tax year (See instructions.) ~~~~~~~~~~~~~~~~

Enter the total tax for the tax year determined without regard to the amount entered

on line 8e ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 9b from line 9a.

��������������������������������������������������

Enter the fair market value of your PFIC stock at the end of the tax year

Enter your adjusted basis in the stock at the end of the tax year

Subtract line 10b from line 10a. If a gain, do not complete lines 11 and 12. Include this amount as ordinary income

on your tax return. If a loss, go to line 11

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter any unreversed inclusions (as defined in section 1296(d)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the loss from line 10c, but only to the extent of unreversed inclusions on line 11. Include this amount as an ordinary

loss on your tax return ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the fair market value of the stock on the date of sale or disposition

Enter the adjusted basis of the stock on the date of sale or disposition

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line 13b from line 13a. If a gain, do not complete line 14. Include this amount as ordinary income on your

tax return. If a loss, go to line 14 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter any unreversed inclusions (as defined in section 1296(d)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the loss from line 13c, but only to the extent of unreversed inclusions on line 14a. Include this amount as an ordinary

loss on your tax return. If the loss on line 13c exceeds unreversed inclusions on line 14a, complete line 14c ~~~~~~~~

Enter the amount by which the loss on line 13c exceeds unreversed inclusions on line 14a. Include this amount on your tax

return according to the rules generally applicable for losses provided elsewhere in the Code and regulations ~~~~~~~

See instructions in case of multiple sales or dispositions.

Form (Rev. 12-2014)

Part III Income From a Qualified Electing Fund (QEF).

Part IV Gain or (Loss) From Mark-to-Market Election (See instructions.)510,000.500,000.

10,000.

17451229 794837 PFIC 2015.01000 Smith, John PFIC2 11

Interest accrued on deferred

tax (line 19) as of the filing date

Earnings distributed or deemed

distributed during the tax year

Deferred tax outstanding after

partial termination of election

51261304-01-15

3

15

16

a

b

c

d

e

f

a

b

c

d

e

f

15a

15b

15c

15d

15e

15f

16b

16c

16d

16e

16f

do not

do not

(i) (ii) (iii) (iv) (v) (vi)

17

18

19

20

21

22

23

24

25

26

8621

Complete a Part V for each excess distribution and disposition (see instructions).

Complete a separate column for each outstanding election. Complete lines 25 and 26 only if there is a partial termination of the section1294 election.

Form 8621 (Rev. 12-2014) Page

Enter your total distributions from the section 1291 fund during the current tax year with respect to the applicable stock. If the

holding period of the stock began in the current tax year, see instructions

Enter the total distributions (reduced by the portions of such distributions that were excess distributions but not

included in income under section 1291(a)(1)(B)) made by the fund with respect to the applicable stock for each of the 3 years

preceding the current tax year (or if shorter, the portion of the shareholder's holding period before the current tax year)

Divide line 15b by 3. (See instructions if the number of preceding tax years is less than 3.) ~~~~~~~~~~~~~~~

Multiply line 15c by 125% (1.25)

Subtract line 15d from line 15a. This amount, if more than zero, is the excess distribution with respect to the applicable stock.

If there is an excess distribution, complete line 16. If zero or less and you did not dispose of stock during the tax year,

complete the rest of Part V. See instructions if you received more than one distribution during the current tax year. Also,

see instructions for rules for reporting a nonexcess distribution on your income tax return ~~~~~~~~~~~~~~~

Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund. If a gain,

complete line 16. If a loss, show it in brackets and complete line 16

If there is a positive amount on line 15e or 15f (or both), attach a statement for each excess distribution and disposition.

Show your holding period for each share of stock or block of shares held. Allocate the excess distribution or gain to each day

in your holding period. Add all amounts that are allocated to days in each tax year.

Enter the total of the amounts determined in line 16a that are allocable to the current tax year and tax years

before the foreign corporation became a PFIC (pre-PFIC years). Enter these amounts on your income tax

return as other income

Enter the aggregate increases in tax (before credits) for each tax year in your holding period

(other than the current tax year and pre-PFIC years). (See instructions.) ~~~~~~~~~~~~~~~~~~~~~~~~

Foreign tax credit. (See instructions.)

Subtract line 16d from line 16c. Enter this amount on your income tax return as "additional tax." (See instructions.)

Determine interest on each net increase in tax determined on line 16e using the rates and methods of section 6621.

Enter the aggregate amount of interest here. (See instructions.)����������������������������

Tax year of outstanding

election

Undistributed earnings to

which the election relates

Deferred tax

Event terminating election

Deferred tax due with this

return

Accrued interest due with

this return

Interest accrued after partial

termination of election ��

Form (Rev. 12-2014)

~~~~~~~~~~~~~~~~~~~~~~~

~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~

~~~~~~~~

~~~~~~

~~~~~~~~~

~~~~~~~

~

separate

Distributions From and Dispositions of Stock of a Section 1291 Fund

Part V

Part VI Status of Prior Year Section 1294 Elections and Termination of Section 1294 Elections

(See instructions.)

17451229 794837 PFIC 2015.01000 Smith, John PFIC2 12

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Form 1040 Miscellaneous Income Statement 1}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

Description Amount}}}}}}}}}}} }}}}}}}}}}}}}}Form 8621, line 10c - Europe Index Mutual Fund 10,000.

}}}}}}}}}}}}}}Total to Form 1040, line 21 10,000.

~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Form 8621 Additional Information Statement 2}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}Name of PFIC or QEF}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}Europe Index Mutual Fund

Number Number Value ofof Shares Change of Shares Shares

Class of at Begining in Number Date of at End Held At JointlyStock of Year of Shares Change of Year Year End Owned

}}}}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}}}}} }}}}}}}}}} }}}}}}}}}} }}}}}}}B 500. 0. 500. 530,000.

John Smith 999-99-9999}}}}}}}}}} }}}}}}}}}}}

Statement(s) 1, 217451229 794837 PFIC 2015.01000 Smith, John PFIC2

13