rom 8283 Noncash Charitable Contributions OMB No. 1545-0908

© 3-31-90
(Rev. August 1988) > Attach to your Federal income tax return if the total claimed |__Exoires 3:37-90
Department ofthe Treasury deduction for all property contributed exceeds $500. Attachment
Internal Revenue Service > See separate Instructions. Sequence No. 55,
Name(s) as shown on your income tax return Identification number

Note: Compute the amount of your contribution deduction before completing Form 8283. (See your tax return instructions.)

Include in Section A only items (or groups of similar items) for which you claimed a deduction of $5,000 or less
per item or group, and certain publicly traded securities (see Instructions).

Information on Donated Property

(a) Name and address of the (b) Description of donated property (attach a
1 donee organization separate sheet if more space is needed)
A
B
c
D
E

Note: Columns (d), (e), and (f) do not have to be completed if the amount you claimed as a deduction for the item is $500 or less.

(c) Date of the (d) Date acquired (e) How acquired (f) Donor's cost or
contribution by donor (mo., yr.) by donor adjusted basis

(h) Method used to determine the fair

(g) Fair market value market value

mm | |e (oo |>

EPS) Other Information—Complete question 2 if you gave less than an entire interest in property listed in Part |.
Complete question 3 if restrictions were attached to a contribution listed in Part |.

2  Ifless than the entire interest in the property is contributed during the year, complete the following:

(a) Enter letter from Part | which identifies the property _____. (Attach a separate statement if Part II applies to more than one
property.)

(b) Total amount claimed as a deduction for the property listed in Part | for this tax year ——__________;
for any prior tax year(s) :

(c) Name and address of each organization to which any such contribution was made in a prior year (complete only if different from the
donee organization above).

Charitable organization (donee) name

Number and street

City or town, state, and ZIP code

(d) The place where any tangible property is located or kept.
(e) Name of any person, other than the donee organization, having actual possession of the property.
3. Ifconditions were attached to any contribution listed in Part I, answer the following questions: Yes | No
(a) Is there a restriction either temporarily or permanently on the donee's right to use or dispose of the donated property? .
(b) Did you give to anyone (other than the donee organization or another organization participating with the donee
organization in cooperative fundraising) the right to the income from the donated property or to the possession of the
property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to Mh
designate the person having such income, possession, orrighttoacquire? . . 2... ee ee
(c) Is there a restriction limiting the donated property for a particular use? .

For Paperwork Reduction Act Notice, see separate Instructions. Form 8283 (Rev. 8-88)



Form 8283 (Rev. 8-88) Page 2
Name(s) as shown on your income tax return Identification number

| Section B EV yerer] Summary—include in Section B only items (or groups of similar items) for which you claimed a
deduction of more than $5,000 per item or group. (Report contributions of certain publicly traded securities only
in Section A.)

If you donated art, you may have to attach the complete appraisal. See the Note in Part II below.
Donee Acknowledgment (To be completed by the charitable organization.)
1 This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated
property as described in Part Il on

(ate)
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property (or any portion
thereof) within two years after the date of receipt, it will file an information return (Form 8282, Donee Information Return) with the
IRS and furnish the donor a copy of that return. This acknowledgment does not represent concurrence in the claimed fair market

value.

Charitable organization (donee) name Employer identification number

Number and street City or town, state, and ZIP code

‘Authorized signature Title Date

iztaaig Information on Donated Property (To be completed by the taxpayer and/or appraiser.)

2 = Check type of property:
CO art* (contribution of $20,000 or more) OO Real Estate Oo Gems/Jewelry O. Stamp Collections
O Art* (contribution of less than $20,000) O Coin Collections O Books O other

*art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antique furniture, decorative arts, textiles, carpets, silver, rare manuscripts,
historical memorabilia, and other similar objects. Note: if you donated art after December 31, 1987, and your total art contribution deduction was $20,000
gr more, you must attach a complete copy of the signed appraisal and include an 8 x 10 inch color photograph (or a color transparency, no smaller than

x 5 inches).

3 (a) Description of donated property (attach a (b) If tangible property was donated, give a brief summary of (c) Appraised fair market
separate sheet if more space is needed) ‘the overall physical condition at the time of the gift value
A
B
Cc
D
See instructions
(d) Date acquired (e) How acquired (f)Donor's cost or | (g) For bargain sales after [~(h) Amount claimed as a_| (1) Average trading price of
by donor (mo., yr.) by donor adjusted basis | 6/6/88, enter amount received deduction securities
A
B
Cc
D

| Part 111 | Taxpayer (Donor) Statement—List any item(s) included in Section B, Part Il, that is (are) separately identified in
the appraisal as having a value of $500 or less. See instructions.

| declare that the following item(s) included in Part Il above has (have) to the best of my knowledge and belief an appraised value of not more than $500 (per
item). (Enter identifying letter from Part Il and describe the specific item):

Signature of taxpayer (donor) > Date >
Certification of Appraiser (To be completed by the appraiser of the above donated property.)

| declare that | am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, married to, or related to any of
the foregoing persons, or an appraiser regulary used by any ofthe foregoing persons and who does not perform a majorty of appraisals during the taxable
year for other persons.

Also, | declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications as described
in the appraisal, | am qualified to make appraisals of the type of property being valued. | certify the appraisal fees were not based upon a percentage of the
appraised property value. Furthermore, | understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or
this appraisal summary may subject me to the civil penalty under section 6701(a) (aiding and abetting the understatement of tax liability). | affirm that |
have not been barred from presenting evidence or testimony by the Director of Practice.

Please

Sign

Here Signature > Title> Date of appraisal >

Business address Identification number

City or town, state, and ZIP code