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SCHEDULE B-1 Information on Certain …

SCHEDULE B-1 (Form 1120S)(Rev. December 2016 )Department of the Treasury internal revenue Service Information on Certain shareholders of an S Corporation Attach to Form 1120S. Information about SCHEDULE B-1 (Form 1120S) and its instructions is at No. 1545-0123 Name of corporationEmployer identification number Information on Any Shareholder That Was a Disregarded Entity, a Trust, an Estate, or a Nominee or Similar Person at Any Time During the Tax Year (Form 1120S, SCHEDULE B, Question 3)(a) Name of Shareholder of Record Disregarded Entity, Trust, Estate, Nominee or Similar Person(b) Social Security Number (SSN) or Employer Identification Number (EIN) (if any) of Shareholder of Record (c) Type of Shareholder of Record(d)

SCHEDULE B-1 (Form 1120S) (Rev. December 2016) Department of the Treasury Internal Revenue Service . Information on Certain Shareholders of an S

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