First, check that this applies to you

This filing is only for a specific kind of LLC. Please answer these 4 questions.

1. How many members (owners) does the LLC have?

Single memberOne owner Multiple membersTwo or more

2. Is the owner a non-U.S. person?

YesA foreign individual or a foreign company NoU.S. citizen, green card holder or U.S. tax resident

3. Did the LLC file Form 8832 or 2553 to be taxed as a C or S corporation?

NoDefault "disregarded entity" YesElected corporate tax treatment

4. Did the LLC carry on an actual business in the U.S. this year?

NoOr no income at all YesU.S. employees, office, warehouse or services performed in the U.S.

Tax year and company

Fill everything in English, exactly as on the state formation documents and the EIN letter (CP 575 / 147C).

Tax year

Company legal name EIN

U.S. address

StreetUsually your registered agent's or business address Suite / Room optional ZIPFills in city and state City State Date formed State of formation optional Total assets at year end$E.g. the bank balance on December 31; 0 if none

Business and this year

Business activity code Business activity (English)

This is the company's first tax year · 1120 "Initial return" This is the first Form 5472 the company files · Form 5472 line 1j The address changed since the last filing The company name changed The company was dissolved this year (final return)

Form 7004 only extends the time to file (to October 15) and must be filed by the original due date, April 15. After it is accepted you still file Form 5472 + pro forma 1120 by October 15.

Owner (foreign shareholder)

This goes in Part II (25% foreign shareholder) and Part III (related party) of Form 5472. Write the name exactly as in your passport, in English letters.

IndividualA foreign national Foreign companyOwned by a non-U.S. company

Name / company name (English) Country of residence Street address (English) City State / province Postal code Foreign tax ID (FTIN)Your home country's tax or national ID number Citizenship Country of tax residence

More (optional)

U.S. ITIN / SSNLeave blank if none Reference ID 4b(2) / 8b(2)Required when there is no ITIN / SSN. Leave blank to generate one from the EIN; use the same ID every year — if you used a different one before, enter that. Owner's business activity

Money between the LLC and its owner

"Zero filing" does not mean all zeros. Formation, registered-agent and state fees the owner paid, and money put into or taken out of the LLC's account, all go in Part V of Form 5472. What counts?

Contributions

Money the owner put in, or expenses the owner paid for the LLC

Distributions

Money the LLC paid to the owner

Loans and other amounts (Part IV — usually empty)

Borrowed from owner · beginning balance 17a$ Borrowed from owner · ending balance 17b$ Loaned to owner · beginning balance 31a$ Loaned to owner · ending balance 31b$ Other amounts received from owner 21$ Other amounts paid to owner 35$ These amounts include estimates

Sign

Your signature goes on the "Signature of officer" line of Form 1120, page 1. Signing declares, under penalties of perjury, that the information is true, correct and complete.

Signer name (English) Title Date signed

Signature

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