For an original statement, complete Parts I and II. For a Supplemental Statement, complete Parts I and III.
Enter your name and taxpayer identification number (TIN) at the top of the form. Then check the box for purchaser or seller.
Part I—General Information
Enter the name, address, and TIN of the other party to the transaction (purchaser or seller). You are required to
enter the TIN of the other party. If the other party is an individual or sole proprietor, enter the social security number.
If the other party is a corporation, partnership, or other entity, enter the employer identification number.
Enter the date on which the sale of the assets occurred.
Enter the total consideration transferred for the assets.
Part II—Original Statement of Assets Transferred
For a particular class of assets, enter the total fair market value of all the assets in the class and the total allocation
of the sales price. For Classes VI and VII, enter the total fair market value of Class VI and Class VII combined, and the
total portion of the sales price allocated to Class VI and Class VII combined.
This line must be completed by the purchaser and the seller. To determine the maximum consideration to be paid, assume
that any contingencies specified in the agreement are met and that the consideration paid is the highest amount possible.
If you cannot determine the maximum consideration, state how the consideration will be computed and the payment period.
Part III—Supplemental Statement
Complete Part III and file a new Form 8594 for each year that an increase or decrease in consideration occurs. See Reallocation after an increase or decrease in consideration, and When To File, earlier. Give the reason(s) for the increase or decrease in allocation. Also, enter the tax year(s) and form number with
which the original and any supplemental statements were filed. For example, enter “2012 Form 1040.”