Transcription of Form OMB No. 1545-2272
1 Form 8975(June 2017) Department of the Treasury Internal Revenue Service country -by- country Report Information about Form 8975 and its separate instructions is at No. 1545-2272 For reporting period beginning, 20, and ending, 20If this is an amended report, check hereEnter the number of Schedules A (Form 8975) attached to this Form 8975 Part IIdentification of Filer1aName of the reporting entity1b reporting role code1c EIN2 Number, street, and room or suite no. (if box, see instructions)3aCity or town3b State or province3c country , and ZIP or foreign postal codePart IIAdditional InformationEnter any additional information related to the multinational enterprise Paperwork Reduction Act Notice, see separate No. 37798 NForm 8975 (6-2017)Form 8975 (6-2017) Page 2 Part IIAdditional Information (continued)Form 8975 (6-2017)