rom 8283

(Rev March 1990)

Department of the Treasury
Internal Revenue Service

Noncash Charitable Contributions (OMB No. 1545-0908,

> Attach to your tax return if the total claimed deduction for all

Expires 2-28-93

property contributed exceeds $500. Attachment

> See separate Instructions.

Sequence No. 55

Name(s) 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 organwzation separate sheet if more space is needed)
A
B
c
D
E
Note: /f the amount you claimed as a deduction for the item is $500 or less, you do not have to complete columns (d), (e), and (f)
(c) Date of the (d) Date acquired (e) How acquired (f) Donor's cost or (h) Method used to determine the fair
‘contribution by donor (mo yr) by donor adjusted basis _| (€) Famrmarket value market value
A
B
c _
| —
E

Other Information—If you gave less than an entire interest in property listed in Part I, complete lines 2a—2e
If restrictions were attached to a contribution listed in Part |, complete lines 3a-3c.

2

3

If less than the entire interest in the property is contributed during the year complete the following:
a_ Enter letter from Part | that identifies the property

b

d_ The place where any tangible property is located or kept

statement.)

(If Part II applies to more than one property, attach a separate

Total amount claimed as a deduction for the property listed in Part | for this tax year
for any prior tax year(s)
Name and address of each organization to which any such contribution was made in a prior year (complete only if different than the
donee organization above).

Name of chantable organization (donee)

Address (number and street)

City or town, state, and ZIP code

e Name of any person, other than the donee organization, having actual possession of the property

If conditions were attached to any contribution listed in Part I, answer the following questions and attach the required

statement (see Instructions): Yes | No

a_ Is there a restriction, either temporary or permanent, 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, or right to acquire?

cs there a restriction limiting the donated property for a particular use?

For Paperwork Reduction Act Notice, see separate Instructions.

Form 8283 (Rev. 3-90)


Form 8283 (Rev. 3-90) Page 2
Name(s) shown on your income tax return Identification number

BEE Appraisal 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 | below.
Information on Donated Property (To be completed by the taxpayer and/or appraiser.)
1 Check type of property:
CO Art* (contribution of $20,000 or more) CO Real Estate O Gems/Jewelry C Stamp Collections

C1 Art* (contribution of less than $20,000) O Coin Collections 0 Books 0 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: /f you donated art after December 31, 1987 and your total art contribution deduction was $20,000
or more, you must attach a complete copy of the signed appraisal. See Instructions.

2 (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
5 See Instructions

Srometeans, | OMoracawet | owes | ipecrmanse [avant amet st WAT aR AEE
A
B
Cc

Fart] Taxpayer (Donor) Statement—List any item(s) included in Part | above 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 ! 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 | and describe the specific item):

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

I 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 regularly used by any of the foregoing persons and who does not perform a majority of appraisals during the taxable
year for other persons.

Also, | declare that | 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 that 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

[ Part V [DYEES Acknowledgment (To be completed by the charitable organization.)

This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property
as described in Parton

(Date)
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property (or any portion thereof)
within 2 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.

Name of charitable organization (donee) Employer identification number
Address (number and street) City or town, state, and ZIP code
‘Authorized signature Title Date

© U.S. GPO, 1992-312-699/60048