976 Claim for Deficiency Dividends Deductions by a Personal
rm Holding Company, Regulated Investment Company or = |" "8"
sepatinont ofthe Teasuy Real Estate Investment Trust fares 30-38

Internal Revenue Service (Under Section 547 or 860 of the Internal Revenue Code)
Name of personal holding company, regulated investment company or real estate investment trust | Employer identification number

(Rev. Dec. 1981)

Address (Number and street)

City, State and ZIP code

1 Amount of tax deficiency 5 How was the deficiency established?
$ (CJ Tax Court Decision—Attach a copy and explain how the decision became final.
2 Tax year(s) involved (J Court Judgment—attach a copy and explain how the decision became final. If established by a final judgment
in a suit against the United States for refund:
3 (a) Amount paid (a) Date the deficiency was paid. 2... we
(b) Date the claim for refund was filed. . . . . . >
3 (b) Date paid (c) Date the suit was brought. . . . 1 ww

[1 Closing Agreement Under Section 7121.

—_________ If a Personal Holding Company, Agreement Under Section 547(c)(3)—Attach a copy of the agreement.

4 Amount unpaid (EJ Ifa Regulated Investment Company or Real Estate Investment Trust, Agreement Under Section 860(e)(3)—Attach
$ a copy of the agreement.

6 Determination date (see instruction 4) 7 Date the deficiency dividend was distributed > Attach a certified copy of the resolution of the board of

directors or other authority authorizing the payment of
the deficiency dividend.

Deficiency | 8 (a) Cash 2
apeficency 8 (b) Other property (attach description):
distributed (i) Fair market value... . 2... . em |S
as follows >| $ (i) Adjusted basis... . . sm SF
9 (a) Amount claimed as a deduction (b) For a regulated investment company or real

for deficiency dividends . . . . . .$ estate investment trust, enter the amount of line

9(a) designated as capital gains dividends. . $
10 A regulated investment company or real estate investment (b) Class of stock and number eg oid Sneek
trust does not have to complete line 10 held at date of payment ‘shareholder on each
(a) Name and address of each shareholder ‘st deficiency dividend ‘class of stock
$

Under penalties of perjury, | declare that | have examined this claim, including accompanying schedules and statements, and to the best. of
Please 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
Pai Preparer's Date gheck if Preparer's social security no.
aid signature » ployed & [) i :
Preparer’s Firas name (or yours, El Nob!
Use Only if self-employed), > | ZIP code >

For Paperwork Reduction Act Notice, see the instructions on the reverse of this form. Form 976 (12-81)


Instructions

(References are to the Internal Revenue Code.)

Paperwork Reduction Act Notice.—The Paperwork Re-
duction Act of 1980 says we must tell you why we are col-
lecting this information, how we will use it, and whether
you have to give it to us. We ask for the information 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. You are required to give us this information.

1, Deficiency Dividends.—Deficiency dividends must be
distributed on, or within 90 days after the determination
date (see instruction 4) and prior to filing this claim.

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
taxable year for which the tax liability exists, if it had been
distributed during that year.

2. Who Must File.—-This form is to be used in cases
where a personal holding company, regulated investment
company or real estate investment trust may be relieved
from payment of a tax deficiency, or may be entitled to a
credit or refund of part or all of any such deficiency which
has been paid, pursuant to section 547 or 860 (whichever
is applicable).

3. How to File.—-This claim must be filed within 120
days after the determination date. If filed by a personal
holding company, it shall be filed with the District Director's
office where the determination was made. If filed by a regu-
lated investment company or real estate investment trust,
it may be filed with the District Director, or Director of the
Internal Revenue Service Center, with whom the income tax
return for the taxable year with respect to which the deter-
mination applies was filed. In the event that the determina-
tion is an agreement with the District Director (or his dele-
gate) described in section 860(e)(3), the claim may be
filed with the District Director with whom the agreement
was made.

4. Determination Date.—The determination date is:

(a) In the case of a decision of the Tax Court, the date
the decision becomes final, as prescribed in section
7481.

(b) In the case of a judgment, decree or order by a
court, the date the judgment, decree or order be-
comes final.

(c) In the case of a closing agreement made under sec-
tion 7121, the date the agreement is approved by
the Commissioner.

(d) In the case of an agreement under section 547
(c)(3) or section 860(e)(3) executed by the District
Director (or other authorized official) and the tax-
payer, if the signed copy of the agreement is sent to

the taxpayer by registered mail, the determination
date is the date of registration. If it is sent by certi-
fied mail, the determination date is the date of the
postmark on the sender’s receipt. However, if a div-
idend is paid by the taxpayer before such registra-
tion or postmark date but on or after the date the
agreement is signed by the District Director, the
determination date shall be the date of such signing.

5. Claim for Credit or Refund.—-If, subsequent to pay-
ment of a tax deficiency, an overpayment results from the
allowance of a deficiency dividend deduction, a claim, in
addition to this form, must be filed on an appropriate
amended income tax return to obtain a credit or refund for
the overpayment.

6. Corporate Acquisitions.—In the case of the acquisi-
tion of assets of a corporation by another corporation in a
distribution or transfer described in section 381(a), see
sections 381(c)(17) and 381(c)(25) for special rules for
claiming a deficiency dividend deduction.

7. Signature.—The return must be signed and dated by
the president, vice president, treasurer, assistant treas-
urer, chief accounting officer, or any other corporate officer
(such as tax officer) authorized to sign. A receiver, trustee,
or assignee must sign and date any return required to be
filed on behalf of a corporation.

If your corporate officer filled in Form 976, the Paid
Preparer’s space under ‘‘Signature of officer’ should re-
main 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 of the
corporation such as a clerk, secretary. etc. does not have
to sign. (This list is not all inclusive.)

Generally, anyone who is paid to prepare Form 976 must
sign the return and fill in the other blanks in the Paid Pre-
parer’s Use Only area of the return.

lf you have questions about whether a preparer Is re-
quired to sign Form 976, please contact an IRS office.

The preparer required to sign the return MUST com-
plete the required preparer information and:

© Sign it, by hand, in the space provided for the preparer’s
signature. (Signature stamps or labels are not acceptable.)

© Give a copy of Form 976 to the taxpayer in addition to
the copy filed with IRS.

Tax return preparers should be familiar with their re-
sponsibilities. See Publication 1045, Information and
Order Blanks for Preparers of Federal Income Tax Returns,
for more details.

#U.S, Government Printing Office: 1983: -381-108/130