Shareholders Information Form Control numberSelect Applicable BoxRoundingShareholderFinal K-1Amended K-1Shareholder Name and Address InformationFirst Name *MILast Name *SuffixProfessionalID NumberTypeNameEntity name (if not individual)Care of/FBO/DBAAddressCityState, ZIPU.SResident stateProvince/state, country, postal codeForeignPhone numberEmail addressDelivery OptionsDeliver by emailOfficer InformationOfficer OptionsSigns returnBooks in care ofTitleDate employed in the position fromDate employed in the position toOfficer's deductible compensationCompensation of officers claimed on Form 1125-A and elsewhere on returnSchedule B1 InformationDescriptionResponsible Party NameSSN/EINEINShares at start of yearShareholder's % of stock ownershipPercentage of Stock OwnershipTotalCommonPreferredTimeNoteSubmitSave as Draft
