Form 8283 OMB No. 1545-0908 Noncash Charitable Contributions Expires 11-30-95

(Rev. November 1992) © Attach to your tax return if the total deduction claimed

for all property contributed exceeds $500. Attachment

Sequence No. 55 Department of the Treasury

Internal Revenue Service © See separate instructions.

Name(s) shown on your income tax return Identifying number

Note: Figure the amount of your contribution deduction before completing this form. See your tax return instructions.

Section A—Include in this section 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—If you need more space, attach a statement.

(b) Description of donated property (a) Name and address of the

donee organization 1

D

Note: If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (d), (e), and (f).

(h) Method used to determine the fair

market value

(f) Donor’s cost

or adjusted basis

(e) How acquired

by donor

(d) Date acquired

by donor (mo., yr.)

(c) Date of the

contribution (g) Fair market value

A

B

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 I, complete lines 3a–3c.

2 If less than the entire interest in the property is contributed during the year, complete the following:

a

Total amount claimed as a deduction for the property listed in Part I: (1) For this tax year

(2) For any prior tax years .

b

c 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 charitable organization (donee)

Address (number, street, and room or suite no.)

City or town, state, and ZIP code

d For tangible property, enter the place where the property is located or kept

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):

3

Yes No

Is there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donated

property?

a

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 designate the person having such income, possession, or right to acquire? 

c Is there a restriction limiting the donated property for a particular use? 

For Paperwork Reduction Act Notice, see separate instructions. Form 8283 (Rev. 11-92)

C

D

A

B

C

E

Part I

Part II

Enter letter from Part I that identifies the property . If Part II applies to more than one property, attach a separate

statement.

Cat. No. 62299J
Form 8283 (Rev. 11-92) Page 2

Name(s) shown on your income tax return Identifying number

Section B—Appraisal Summary—Include in this section 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 I below.

Information on Donated Property—To be completed by the taxpayer and/or appraiser.

4 Check type of property:

Art* (contribution of $20,000 or more) Real Estate Gems/Jewelry

Art* (contribution of less than $20,000) Coin Collections Books Other

*Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antique furniture, decorative arts, textiles, carpets, silver, rare

manuscripts, historical memorabilia, and other similar objects.

(c) Appraised fair

market value

(b) If tangible property was donated, give a brief summary of the overall

physical condition at the time of the gift

(a) Description of donated property (if you need

more space, attach a separate statement)

5

A

C

D

See instructions (g) For bargain sales, enter

amount received

(f) Donor’s cost or 

adjusted basis

(e) How acquired 

by donor

(d) Date acquired 

by donor (mo., yr.) (i) Average trading price of securities (h) Amount claimed as a 

deduction

A

B

C

D

Taxpayer (Donor) Statement—List each item included in Part I above that is separately identified in the

appraisal as having a value of $500 or less. See instructions.

I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500

(per item). Enter identifying letter from Part I and describe the specific item:

Signature of taxpayer (donor) © Date ©

Certification of Appraiser

I declare that I 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, I declare that I 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, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based

upon a percentage of the appraised property value. Furthermore, I 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). I affirm that I have not been barred from presenting evidence or testimony by the Director of Practice.

Sign

Here Signature © Title © Date of appraisal ©

Business address (including room or suite no.) Identifying number

City or town, state, and ZIP code

Donee 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 Section B, Part I, above on (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, street, and room or suite no.) City or town, state, and ZIP code

Authorized signature Title Date

B

Stamp Collections

Part III

Part IV

Part I

Part II

Note: If your total art contribution deduction was $20,000 or more, you must attach a complete copy of the signed appraisal. See instructions.