Claim for Deficiency Dividends Deductions by a

Personal Holding Company, Regulated Investment

Company, or Real Estate Investment Trust

Form 976

OMB No. 1545-0045

Expires 5-31-95

(Rev. April 1992)

Department of the Treasury

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

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 Amount paid 3a

Date paid , 19 .

4 4 Amount unpaid

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 , 19 .

Date the suit was brought , 19 .

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 Deficiency determination date (see instructions) , 19 .

Date the deficiency dividend was distributed , 19 . (Attach a certified copy of the

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

7

8 Deficiency dividend was distributed as follows:

Cash 8a

Other property (attach description):

Fair market value 8b(1) (1)

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 Please 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 Preparer’s social security number Check if

self-employed ©

Preparer’s Paid signature

Preparer’s

Use Only Firm’s name (or yours,

if self-employed)

and address

E.I. No. ©

ZIP code ©

For Paperwork Reduction Act Notice, see back of form. Form 976 (Rev. 4-92)

b

(1)

(2)

a

b

b

Tax year(s) ended , 19 ; , 19 ; , 19 .

©

©

©

©

Cat. No. 17061B

a

b

c

d

e
Form 976 (Rev. 4-92) Page 2

Instructions

(Section references are to the Internal Revenue Code. )

Recordkeeping 5 hr., 44 min.

Learning about the law or the form 47 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 personal holding company to

establish the personal holding company’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 deficiency

determination date 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.

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.

Paperwork Reduction Act Notice.—We ask for the

information on this form to carry out the Internal Revenue

laws of the United States. You are required to give us the

information. 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.

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

more simple, we would be happy to hear from you. You

can write to both the Internal Revenue Service,

Washington, DC 20224, Attention: IRS Reports Clearance

Officer, T:FP, and the Office of Management and

Budget, Paperwork Reduction Project (1545-0045)

Washington, DC 20503. DO NOT send this form to either

of these offices. Instead, see When and Where To File

below.

Purpose of Form.—File Form 976 for a personal holding

company, regulated investment company, or real estate

investment trust that is claiming a deficiency dividend

deduction under section 547 or 860. If the deficiency

dividend deduction is granted, taxpayers will be granted

relief, in whole or in part, from the payment of a tax

deficiency. If the deficiency has already been paid, the

taxpayers must file an amended return to claim a credit or

refund.

When and Where To File.—File Form 976 within 120

days after the deficiency determination date (defined

below). A personal holding company must file Form 976

with the District Director’s office where the determination

of personal holding company status was made. A

regulated investment company or a real estate investment

trust must file Form 976 with either the District Director or

with the Internal Revenue Service Center where the

company or trust filed its income tax return for the tax

year for which the determination applies.

If the deficiency determination is from an agreement

with the District Director or delegate (under section

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

deficiency dividend deduction may be filed with that

District Director.

Deficiency Determination Date.—The deficiency

determination date is as follows:

● For a decision of the Tax Court, the date the decision

becomes final under section 7481.

● For a judgment, decree, or order by a court, the date

the judgment, decree, or order becomes final.

● For a closing agreement made under section 7121, the

date the agreement is approved by the Commissioner.

● If an agreement was made by the District Director and

the taxpayer under section 547(c)(3) (Form 2198) 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

District Director, the determination date is the date the

agreement was signed.

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.

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 55 min.