1217 Form 8937 (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8937.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

14 Describe the organizational action and, if applicable, the date of the action or the date against which shareholders' ownership is measured for the action ^▶

15 Describe the quantitative effect of the organizational action on the basis of the security in the hands of a U.S. taxpayer as an adjustment per share or as a percentage of old basis ^▶

16 Describe the calculation of the change in basis and the data that supports the calculation, such as the market values of securities and the valuation dates ^▶

For Paperwork Reduction Act Notice, see the separate Instructions. Cat. No. 37752P Form 8937 (12-2017)

Form 8937 (12-2017) Page 2 Part II Organizational Action (continued)

17 List the applicable Internal Revenue Code section(s) and subsection(s) upon which the tax treatment is based ^▶

18 Can any resulting loss be recognized? ^▶

19 Provide any other information necessary to implement the adjustment, such as the reportable tax year ^▶

Sign Here	Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Signature ▶ Date ▶ Print your name ▶ Title ▶
Paid Preparer Use Only	Paid Preparer Use Only	Print/Type preparer's name	Preparer's signature	Date	Check if self-employed	PTIN
Paid Preparer Use Only	Paid Preparer Use Only	Firm's name▶	Firm's name▶	Firm's name▶	Firm's EIN▶	Firm's EIN▶
Paid Preparer Use Only	Paid Preparer Use Only	Firm's address▶	Firm's address▶	Firm's address▶	Phone no.	Phone no.

Send Form 8937 (including accompanying statements) to: Department of the Treasury, Internal Revenue Service, Ogden, UT 84201-0054