ertain income re-sourced by treaty OMB No. 1545-0121 2014 AttelC5O111111 SMoloo0o No 19 Identifying number x. shown co pogo I of you' IDX MUM e EJ Lump-sum distributions f Resident of (name of country)► UNITED STATES Note: If you paid taxes to only one foreign country or U.S. possession, use column