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Enter your data separately for each tax lot (i.e. purchase date):
1. Name of original stock:

or enter your own data:
2. Name of new stock received after bankruptcy reorganization
3. Date of bankruptcy filing (mm/dd/yyyy)
4. Date of emergence from bankruptcy (mm/dd/yyyy)
5. Bankruptcy proceeds exchange ratio (number of new shares for each original share)
6. Tax status of bankruptcy proceeds--enter 1 if tax-free or 2 if taxable
7. Purchase date for original stock (mm/dd/yyyy)
8. Number of shares of original stock owned prior to bankruptcy
(no commas)
9. Total cost basis for original shares, including commissions and fees, adjusted for previous spinoffs (total, not per share)
$ (no commas)
10. Rounding convention used for bankruptcy proceeds fractional shares
11. Cash received in lieu of fractional shares (often denoted as CIL) (enter 0.00 if none)
12. If tax status is type 2, also provide the market value per share of the new stock on the date you received it (open, average, or closing price.) Use the market value per share that the brokerage firm used to compute the taxable proceeds on your Form 1099.
11. Comment
12. Name of tax information statement, if available
13. Account or Owner Name (optional)