Part III

Annual Return for Partnership Withholding Tax (Section 1446) OMB No. 1545-1119

Form 8804 See separate Instructions for Forms 8804, 8805, and 8813.

Attach Form(s) 8804-C and 8805. Department of the Treasury

Internal Revenue Service For calendar year 2009 or tax year beginning , 2009, and ending , 20

Check this box if the partnership keeps its records and books of account outside the United States and Puerto Rico 

Partnership

1a b U.S. employer identification number

For IRS Use Only

CC FD

RD FF

CAF FP

CR I

EDC

Withholding Agent

Withholding agent’s U.S.

employer identification number

Name of withholding agent. If partnership is also the withholding agent, enter “SAME” and do not b

complete lines 2b, 2c, or 2d.

2a

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

d City, state, and ZIP code

Section 1446 Tax Liability and Payments

3a Enter number of foreign partners 

4 Total effectively connected taxable income allocable to foreign partners (see instructions):

Part I

Part II

Name of partnership

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

City, state, and ZIP code. If a foreign address, see instructions.

c

d

a Net ordinary income and net short-term capital gain

e 28% rate gain allocable to non-corporate partners

Unrecaptured section 1250 gain allocable to non-corporate

partners

i

4a

4c

4i

m Qualified dividend income and net long-term capital gain (including

net section 1231 gain) allocable to non-corporate partners 4m

For Privacy Act and Paperwork Reduction Act Notice, see separate Instructions for Form 8804 (2009)

Forms 8804, 8805, and 8813.

Cat. No. 10077T

Reduction to line 4a for certified foreign partner-level items

submitted using Form 8804-C

c

d Combine lines 4a, 4b, and 4c 4d

4e

4g

Reduction to line 4e for certified foreign partner-level items

submitted using Form 8804-C

g

h Combine lines 4e, 4f, and 4g 4h

4o

Reduction to line 4m for certified foreign partner-level items

submitted using Form 8804-C

o

p Combine lines 4m, 4n, and 4o 4p

2009

k Reduction to line 4i for certified foreign partner-level items

submitted using Form 8804-C 4k

l Combine lines 4i, 4j, and 4k 4l

b Reduction to line 4a for state and local taxes under Regulations

section 1.1446-6(c)(1)(iii) 4b

4f

Reduction to line 4e for state and local taxes under Regulations

section 1.1446-6(c)(1)(iii)

f

j Reduction to line 4i for state and local taxes under Regulations

section 1.1446-6(c)(1)(iii) 4j

4n

n Reduction to line 4m for state and local taxes under Regulations

section 1.1446-6(c)(1)(iii)

( )

( )

( )

( )

( )

( )

( )

( )

Enter number of Forms 8805 attached to this Form 8804 

Enter number of Forms 8804-C attached to Forms 8805 

b

c
11

10

Overpayment. If line 7 is more than line 9, enter amount overpaid

12

11

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 general partner, limited liability company member, or withholding agent)

is based on all information of which preparer has any knowledge.

Sign

Here

Signature of general partner, limited liability company Title Date

member, or withholding agent

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if

self-employed Paid

Preparer’s

Use Only Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN 

Phone no.

Form 8804 (2009)







13

Amount of line 11 you want refunded to you 

13 Amount of line 11 you want credited to next year’s Form 8804

( )

Form 8804 (2009) Page 2

9 Add lines 5e and 8 9

10

Balance due. If line 7 is smaller than line 9, enter balance due. Attach a check or money

order for the full amount payable to the “United States Treasury.” Write the partnership’s U.S.

employer identification number, tax year, and Form 8804 on it

12

Payments of section 1446 tax made by the partnership identified

on line 1a during its tax year (or with a request for an extension of

time to file) and amount credited from 2008 Form 8804

6a

6a

Section 1446 tax paid or withheld by another partnership in which

the partnership identified on line 1a was a partner during the tax

year (attach Form(s) 1042-S or 8805)

b

6b

Section 1445(a) or 1445(e)(1) tax withheld from or paid by the

partnership identified on line 1a during the tax year for a disposition

of a U.S. real property interest. Attach Form(s) 1042-S or 8288-A.

See the instructions

c

6c

7 Total payments. Add lines 6a through 6c 7

8 Estimated tax penalty (see instructions). Check if Schedule A (Form 8804) is attached 8

5 Gross section 1446 tax liability:

a Multiply line 4d by 35% (.35) 5a

b Multiply line 4h by 28% (.28) 5b

c Multiply line 4l by 25% (.25) 5c

d Multiply line 4p by 15% (.15) 5d

e Add lines 5a through 5d 5e