1210 Form 5713 (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f5713.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Form

(Rev. December 2010)

Department of the Treasury Internal Revenue Service

For tax year beginning , 20 ,

and ending , 20 .

• Controlled groups, see instructions.

OMB No. 1545-0216

Attachment Sequence No. 123

Paper filers must file in duplicate (see When and Where to File in the instructions)

Name Identifying number

Number, street, and room or suite no. If a P.O. box, see instructions.

City or town, state, and ZIP code

Address of service center where your tax return is filed

Type of filer (check one):

Individual Partnership Corporation Trust Estate Other 1 Individuals— Enter adjusted gross income from your tax return (see instructions) 2 Partnerships and corporations: a Partnerships—Enter each partner’s name and identifying number.

b Corporations—Enter the name and employer identification number of each member of the controlled group (as defined in

section 993(a)(3)). Do not list members included in the consolidated return; instead, attach a copy of Form 851. List all other members of the controlled group not included in the consolidated return. If you list any corporations below or if you attach Form 851, you must designate a common tax year. Enter on line 4b the name and employer identification number of the corporation whose tax year is designated.

3 Partnerships— Each partnership filing Form 5713 must give the following information: a Partnership’s total assets (see instructions) . . . . . . . . . . . . . . . b Partnership’s ordinary income (see instructions) . . . . . . . . . . . . . 4 Corporations— Each corporation filing Form 5713 must give the following information: a Type of form filed (Form 1120, 1120-FSC, 1120-IC-DISC, 1120-L, 1120-PC, etc.) . . . b Common tax year election (see instructions)

(1) Name of corporation ^▶ (2) Employer identification number . . . . . . . . . . . . . . . . . (3) Common tax year beginning, 20 , and ending , 20 . c Corporations filing this form enter:

(1) Total assets (see instructions) . . . . . . . . . . . . . . . . . . (2) Taxable income before net operating loss and special deductions (see instructions) . .

5 Estates or trusts— Enter total income (Form 1041, page 1) . . . . . . . . . 6 Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions): a Foreign tax credit . . . . . . . . . . . . . . . . . . . . . . . b Deferral of earnings of controlled foreign corporations . . . . . . . . . . . c Deferral of IC-DISC income . . . . . . . . . . . . . . . . . . . . d FSC exempt foreign trade income . . . . . . . . . . . . . . . . . . e Foreign trade income qualifying for the extraterritorial income exclusion . . . . . Please Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my

knowledge and belief, it is true, correct, and complete.

Sign Here

Signature Date Title

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12030E Form 5713 (Rev. 12-2010)

Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature Date

Form 5713 (Rev. 12-2010) Page 2

this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^▶

IC-DISCs only—Enter product code

(5)

Name of country

(1)

Identifying number of person having operations

(2)

Code

(3)

Principal business activity

Description

(4)

a

b

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Form 5713 (Rev. 12-2010)

Form 5713 (Rev. 12-2010) Page 3 Yes No 9 Nonlisted countries boycotting Israel— Did you have operations in any nonlisted country which you know or have reason to know requires participation in or cooperation with an international boycott directed against Israel? If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^▶

IC-DISCs only—Enter product code

(5)

Name of country

(1)

Identifying number of person having operations

(2)

Code

(3)

Principal business activity

Description

(4)

a

b

c

d

e

f

g

h

Yes No

10 Boycotts other than the boycott of Israel— Did you have operations in any other country which you know or have reason to know requires participation in or cooperation with an international boycott other than the boycott of Israel? If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check

If “Yes,” attach a copy (in English) of any and all boycott clauses agreed to, and attach a general statement of the agreement. If the agreement was in a form other than a written agreement, attach a separate sheet explaining the nature and form of any and all such agreements. (See instructions.) Note: If the answer to either question 11 or 12 is “Yes,” you must complete the rest of Form 5713. If you answered “Yes” to question 12, you must complete Schedules A and C or B and C (Form 5713).

Form 5713 (Rev. 12-2010)

Form 5713 (Rev. 12-2010) Page 4

b Requests and agreements— if the answer to any part of 13a is “Yes,” complete the following table. If more space is

needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . ^▶

Type of cooperation or participation

Number of requests Number of agreements

Code

(3)

Name of country

(1)

Identifying number of

person receiving the request or having the

agreement

(2)

Principal business activity

IC-DISCs

only—

Enter product code (5)

Total

(6)

Code

(7)

Code

(9)

Description

(4)

Total

(8)

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Form 5713 (Rev. 12-2010)