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Enter your data separately for each tax lot (i.e. purchase date):
1. Name of stock rights received
or enter your own data:
2. Features of rights issuance
3. Record date of stock rights (mm/dd/yyyy)
4. Date of distribution (pay date) of stock rights (mm/dd/yyyy)
5. Purchase date of original stock--tax lot (mm/dd/yyyy)
6. Rights distribution ratio (for example 0.5 if receive 1 right for each 2 shares )
7. Percent allocation of cost basis to stock rights received (for example, 0.2 for 20%)
8. Percent allocation of cost basis to original stock (for example 0.8 for 80%)
9. Number of shares of original stock, adjusted for splits since purchase (no commas)
10. Adjusted cost basis of original stock purchase, including commissions and fees, immediately prior to stock rights issuance $ (no commas)
11. Cash received if stock rights were sold $ (no commas)
12. Tax status of rights issued, enter 1 for tax-free issuance, 2 for taxable dividend
13. If tax status is taxable, enter taxable dividend value per stock right received. $ (no commas)
14. Cash received in lieu of fractional stock rights (enter 0.00 if none) $ (no commas)
15. Number of rights you exercised to subscribe for shares (enter 0.00 if none) (no commas)
16. Exercise ratio of shares per stock right (no commas)
17. Subscription exercise price per share $ (no commas)
18. Date that rights were exercised (mm/dd/yyyy) (no commas)
19. Number of rights you sold (enter 0.00 if none) (no commas)
20. Total sales proceeds you received from sale of rights (enter 0.00 if none) $ (no commas)
21. Date that rights were sold (mm/dd/yyyy) (no commas)
22. Account number or owner name (optional)
Name of tax information statement if available