Form 8804

Department of the Treasury 

Internal Revenue Service 

Annual Return for Partnership Withholding Tax (Section 1446)

▶ Information about Form 8804 and its instructions is at www.irs.gov/form8804.

▶ Attach Form(s) 8804-C and 8805.

 For calendar year 2012 or tax year beginning , 2012, and ending , 20

OMB No. 1545-1119

2012

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

Part I Partnership

1a Name of partnership b U.S. employer identification number

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

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

For IRS Use Only

CC

RD

CAF

CR

EDC

FD

FF

FP

I

Part II Withholding Agent

2a Name of withholding agent. If partnership is also the withholding agent, enter “SAME” and do not 

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

b Withholding agent's U.S. 

 employer identification number

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

d City, state, and ZIP code

Part III Section 1446 Tax Liability and Payments

3a Enter number of foreign partners . . . . . . . . . . . . . ▶

b Enter number of Forms 8805 attached to this Form 8804 . . . . . ▶

c Enter number of Forms 8804-C attached to Forms 8805 . . . . . ▶

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

a Net ordinary income and net short-term capital gain . . . . . 4a

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

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

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

submitted using Form 8804-C . . . . . . . . . . . . 4c ( )

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

e 28% rate gain allocable to non-corporate partners . . . . . 4e

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

section 1.1446-6(c)(1)(iii) . . . . . . . . . . . . . . 4f ( )

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

submitted using Form 8804-C . . . . . . . . . . . . 4g ( )

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

i Unrecaptured section 1250 gain allocable to non-corporate 

partners . . . . . . . . . . . . . . . . . . . 4i

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

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

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

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

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

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

section 1.1446-6(c)(1)(iii) . . . . . . . . . . . . . . 4n ( )

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

submitted using Form 8804-C . . . . . . . . . . . . 4o ( )

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

For Paperwork Reduction Act Notice, see separate instructions for Forms 8804, 8805, and 8813. Cat. No. 10077T Form 8804 (2012) 
Form 8804 (2012) Page 2 

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

6a 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 2011 Form 8804 . . . . . 6a

b Section 1446 tax paid or withheld by another partnership in which

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

year (enter only amounts reported on Form(s) 8805 and attach 

these Form(s) 8805 to Form 8804) . . . . . . . . . . . 6b

c Section 1446 tax paid or withheld by another partnership in which

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

year (enter only amounts reported on Form(s) 1042-S and attach

these Form(s) 1042-S to Form 8804) . . . . . . . . . . 6c

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

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

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 . . . . . . . . . . . 10

11 Overpayment. If line 7 is more than line 9, enter amount overpaid . . . . . . . . . . 11

12 Amount of line 11 you want refunded to you . . . . . . . . . . . . . . . . ▶ 12

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

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

based on all information of which preparer has any knowledge.

▲

Signature of general partner, limited liability company 

member, or withholding agent Title Date

Paid 

Preparer 

Use Only

Print/Type preparer's name Preparer’s signature Date Check if 

self-employed 

PTIN

Firm's name ▶

Firm's address ▶

Firm's EIN ▶

Phone no. 

Form 8804 (2012) 

d 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 (enter only amounts reported on 

Form(s) 8288-A and attach these Form(s) 8288-A to Form 8804) .

e Section 1445(e) tax withheld from the partnership identified on line

1a during the tax year for a disposition of a U.S. real property 

interest (enter only amounts reported on Form(s) 1042-S and attach

these Form(s) 1042-S to Form 8804) . . . . . . . . . .

6d

6e