Federal Free Printable Form 14452 (Rev. 3-2013) for 2017 Federal Foreign Account or Asset Statement

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Foreign Account or Asset Statement
Form 14452 (Rev. 3-2013)

Form 14452 (March 2013) Department of the Treasury–Internal Revenue Service Statement Foreign Account or Asset Statement of OMB Number 1545-2241 Name Social Security Number Submit a separate Statement for each foreign account or asset included in your voluntary disclosure. At least one Statement must be submitted. Respond to each applicable question in the space provided—attachments are appropriate should additional space be necessary. 1. Name of Foreign Financial Institution 2. Country where Institution is located 3. Contact person at this Institution 4. Is the offshore account a bank account holding cash, money market, or CD Yes No 5. Is the offshore account a custodial account holding securities Yes No 6. Is the offshore account another type of account or asset Yes No 7. If so, what type of account or asset Bank or Financial Accounts 8. Source of funds within the account 9. Name under which the account was held 10. If held by an entity, type of entity 11. Date account was opened 13. Does the account include Passive Foreign Investment Company (PFIC) or mutual funds Yes 12. Date account was closed No Other Other Assets (real estate, artwork, bullion, etc.) 14. Description and location of the asset 15a. Purchase price 15b. Date acquired 16a. Sales price (if sold) 16b. Date of disposition 17. FMV at 12/31/2010 if asset is still owned The highest value of this account and/or fair market value of asset over the period of the voluntary disclosure should be included on the Penalty Computation Worksheet. Privacy Act and Paperwork Reduction Act Notice We ask for the information on this foreign account or asset statement to carry out the Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This information will be used to determine and collect the correct amount of tax under the terms of the offshore voluntary disclosure program. You are not required to apply for participation in the offshore voluntary disclosure program. If you choose to apply, however, you are required to provide all the information requested on the foreign account or asset statement. You are not required to provide the information requested on a document that is subject to the Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application. Providing false information may subject you to penalties. The time needed to complete and submit the foreign account or asset statement will vary depending on individual circumstances. The estimated average time is: 2 hour. If you have comments concerning the accuracy of this time estimate or suggestions for making the foreign account or asset statement simpler, we would be happy to hear from you. Comments should be sent to the Internal Revenue Service, Attn: IRS Reports Clearance Officer, SE:W:CAR:MP:T:T:SP, Washington, DC 20224. Catalog Number 61597G www.irs.gov Form 14452 (3-2013)
Extracted from PDF file 2016-federal-form-14452.pdf, last modified March 2013

More about the Federal Form 14452 Other TY 2016

We last updated the Foreign Account or Asset Statement in May 2017, so this is the latest version of Form 14452, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 14452 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 14452 from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 14452

We have a total of two past-year versions of Form 14452 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 14452

Form 14452 (Rev. 3-2013)

Foreign Account or Asset Statement 2015 Form 14452

Form 14452 (Rev. 3-2013)


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