Date paid

Claim for Deficiency Dividends Deductions by a

Personal Holding Company, Regulated Investment

Company, or Real Estate Investment Trust

Form 976

(Rev. May 2010) OMB No. 1545-0045

Department of the Treasury

Internal Revenue Service (Under Section 547 or 860 of the Internal Revenue Code)

Name of entity Employer identification number

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

City or town, state, and ZIP code

Amount of tax deficiency 1 1

2

3a 3a Amount paid 

4 4 Amount unpaid. Subtract line 3a from line 1 

5 How was the deficiency established?

Tax Court Decision—Attach a copy.

Court Judgment—Attach a copy. If established by a final judgment in a suit against the

United States for refund:

Date the claim for refund was filed

Date the suit was brought

Closing agreement under section 7121.

If a personal holding company, agreement under section 547(c)(3)—Attach a copy of a

properly executed Form 2198.

If a regulated investment company or real estate investment trust, agreement under

section 860(e)(3)—Attach a copy of the agreement.

6 Determination date (see instructions)

7 Date the deficiency dividend was distributed

8 Deficiency dividend was distributed as follows:

Cash 8a

Other property (attach description):

8b(1) (1) Fair market value 

Adjusted basis 8b(2) (2)

9a Amount claimed as a deduction for deficiency dividends 9a

For a regulated investment company or real estate investment trust, enter the amount of

line 9a designated as capital gain dividends 9b

10 Only personal holding companies must complete line 10.

(c) Amount of deficiency dividend

paid to each shareholder on each

class of stock

(b) Class of stock and number of

shares of each class of stock held at

date of payment of deficiency dividend

(a) Name and address of each shareholder

Under penalties of perjury, I declare that I have examined this claim, 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 taxpayer) is based on all information of which preparer has any knowledge. Sign

Here

Signature of officer Date Title

Date SSN or PTIN Check if

self-employed ©

Preparer’s Paid signature

Preparer’s

Use Only Firm’s name (or yours

if self-employed),

address and ZIP code

EIN

Phone no. ( )

b

(1)

(2)

a

b

b

Tax year of deficiency ends:

©

©

©

©

a

b

c

d

e

. / /

(Attach a certified copy of the

resolution of the board of directors or other authority authorizing the payment of the deficiency dividend.)

. / /

. / /

. / /

. / /

. / /

If a regulated investment company or real estate investment trust, a statement under 

section 860(e)(4)—Attach a copy of the Form 8927 filed with the IRS (see instructions).

f

Type of entity filing the claim:

Regulated investment company

Personal holding company

Real estate investment trust
Form 976 (Rev. 5-2010) Page 2

Instructions

Section references are to the Internal Revenue Code unless otherwise

noted.

Recordkeeping 5 hr., 44 min.

Learning about the law or the form 53 min.

Form 2198. Form 2198, Determination of Liability for Personal Holding

Company Tax—Section 547(c)(3) of the Internal Revenue Code, is used

as the agreement required by section 547(c)(3). The form is jointly signed

by a delegate of the Commissioner of Internal Revenue and a qualified

officer of the PCH to establish the PCH’s tax liability.

Corporate acquisitions. When the assets of one corporation are

acquired by another corporation in a distribution or transfer described in

section 381(a), see sections 381(c)(17) and 381(c)(23) for special rules for

claiming a deficiency dividend deduction.

If an officer completed Form 976, the Paid Preparer’s space under

“Signature of officer” should remain blank. If someone prepares Form

976 and does not charge the corporation, that person should not sign the

return. Certain others who prepare Form 976 should not sign. For

example, a regular, full-time employee, such as a clerk, secretary, etc.,

should not sign.

Generally, anyone who is paid to prepare Form 976 must sign the

return and fill in the other blanks in the Paid Preparer’s Use Only area of

the return.

Deficiency dividends. Deficiency dividends must be distributed no later

than 90 days after the determination date (defined below) and prior to

filing Form 976.

The preparer required to sign the return must complete the required

preparer information and:

The deficiency dividend must be of such a nature as would have

permitted its inclusion in the computation of the deduction for dividends

paid under section 561 for the tax year for which the tax liability exists, if

it had been distributed during that year. ● Sign it, by hand, in the space provided for the preparer’s signature

(signature stamps or labels are not acceptable) and

● Give a copy of Form 976 to the taxpayer in addition to the copy filed

with the IRS.

Privacy Act and Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue laws of the

United States. We need it to ensure that you are complying with these

laws and to allow us to figure and collect the right amount of tax. If you

claim a deficiency dividend deduction under section 547 or 860, you

must provide this information. Section 6109 requires filers and paid

preparers provide their identification numbers. Failure to provide this

information may delay or prevent the processing of your claim. Providing

false information may subject you to penalties. We may disclose this

information to the Department of Justice for civil or criminal litigation, to

Federal benefits agencies as authorized by law, and to cities, states, and

the District of Columbia for use in administering their tax laws. We may

also disclose this information to other countries under a tax treaty, to

Federal and state agencies to enforce Federal nontax criminal laws, or to

Federal law enforcement and intelligence agencies to combat terrorism.

The time needed to complete and file this form will vary depending on

individual circumstances. The estimated average time is:

If you have comments concerning the accuracy of these time

estimates or suggestions for making this form simpler, we would be

happy to hear from you. You can write to Internal Revenue Service, Tax

Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111

Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this

form to this office. Instead, see When and where to file above.

Purpose of form. File Form 976 for a personal holding company (PHC),

regulated investment company (RIC), or real estate investment trust

(REIT) that is claiming a deficiency dividend deduction under section 547

or 860. If the claim is allowed, taxpayers will be relieved, in whole or in

part, from the payment of certain taxes (or allowed a credit or refund of

certain taxes). In addition, a RIC or REIT will owe interest determined with

respect to the amount of the deficiency dividend deduction allowed, and

a RIC will owe a corresponding penalty. See sections 860(a), 860(c),

6601, 6621, and 6697. The Service will notify the RIC or REIT of the

amount of interest and penalty.

When and where to file. File Form 976 within 120 days after the

determination date (defined below). A PHC must file Form 976 with the

IRS office where the determination of PHC status was made. A RIC or a

REIT must file Form 976 with the Internal Revenue Service Center where

the income tax return for the tax year for which the determination applies

was filed, unless the situations below apply.

If the determination is from an agreement with the delegate (under

section 547(c)(3) or 860(e)(3)) any claim resulting from the deficiency

dividend deduction may be filed with the delegate or corresponding IRS

office.

Determination date. If the determination was made by:

● A decision of the Tax Court, the determination date is the date the

decision becomes final under section 7481.

● A judgment, decree, or order by a court, the determination date is the

date the judgment, decree, or order becomes final.

● A closing agreement made under section 7121, the determination date

is the date the agreement is approved by the Commissioner.

● An agreement between the IRS and the taxpayer under section

547(c)(3) (Form 2198) (see below) or section 860(e)(3) and the signed

copy of the agreement is sent to the taxpayer by registered mail, the

determination date is the date of the registration. If the agreement is sent

by certified mail, the determination date is the date of the postmark on

the sender’s receipt. But if the dividend is paid before the registration or

postmark date, and on or after the date the agreement is signed by the

delegate of the Commissioner, the determination date is the date the

agreement was signed.

Signature. The return must be signed and dated by the president, vice

president, treasurer, assistant treasurer, chief accounting officer, or any

other officer (such as tax officer) authorized to sign. A receiver, trustee, or

assignee must sign and date any return filed on behalf of the company or

trust.

Preparing, copying, assembling, and

sending the form to the IRS 1 hr., 2 min.

You are not required to provide the information requested on a form

that is subject to the Paperwork Reduction Act unless the form displays a

valid OMB control number. Books or records relating to a form or its

instructions must be retained as long as their content may become

material in the administration of any Internal Revenue law. Generally, tax

return and return information are confidential, as required by section

6103.

● A RIC or REIT under section 860(e)(4) (Form 8927), in general, the

determination date is the date Form 8927 was mailed to the IRS. See

Rev. Proc. 2009-28 for more information. A RIC or REIT should retain

written evidence with its records to establish the date Form 8927 was

mailed.

Line 2. Enter the ending date of the tax year for which the deficiency

dividend deduction is claimed. A separate Form 976 must be filed for

each deficiency dividend deduction claimed.

Claim for credit or refund. If the allowance of the deficiency dividend

deduction results in an overpayment of tax, the taxpayer must file an

amended income tax return in addition to Form 976 to obtain a credit or

refund of the overpayment.

If the determination is made by a RIC or REIT under section 860(e)(4),

file Form 976 with the Internal Revenue Service, P.O. Box 9941, Mail

Stop 4912, Ogden, UT 84409. This is the same address for filing Form

8927, Determination Under Section 860(e)(4) by a Qualified Investment

Entity.

Enter this date on line 6.

Line 1. Enter the amount of the tax liability established by the

determination without taking into account the deficiency dividend

deduction claimed and without regard to whether the tax liability is (or

was) a deficiency as defined under section 6211(a)(1).

Line 3a. Enter the amount paid, if any, of the tax liability entered on line

1 without taking into account the deficiency dividend deduction.

Line 5f. A RIC or REIT can file Form 8927 with the IRS to make a

self-determination. If a statement is used instead of Form 8927, attach a

copy of the statement to Form 976.

Line 6. See Determination date, earlier, for more information.

Line 8(b). If a stock distribution by a publicly traded RIC or REIT meets

all the requirements of section 3.02 of Rev. Proc. 2010-12, the RIC or

REIT that made the distribution must enter the fair market value of the

stock distributed on line 8(b)(1) and is not required to complete line

8(b)(2). See Rev. Proc. 2010-12 for more information.

Address. Include the suite, room, or other unit number after the street

address. If the Post Office does not deliver mail to the street address and

the taxpayer has a P.O. box, show the box number instead of the street

address.