Form 8927 860-2(b)(1)

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8927, PAGE 1 of 2, (Page 2 is Blank)
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20.
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

8927

Date

Revised proofs
requested

OMB No. 1545-XXXX

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or tax period beginning

Signature

O.K. to print

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

Form
(October 2008)
Department of the Treasury
Internal Revenue Service
For calendar year 20

Action

See instructions.

, 20

, and ending

Name of regulated investment company (RIC) or real estate investment trust (REIT)

, 20

.

Employer identification number (EIN)

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

City or town, state, and ZIP code

Service Center where the tax return for the year entered above was or will be filed

Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete.

Sign
Here

©

Signature of officer

Title

Date

General Instructions

Date of Determination

Section references are to the Internal
Revenue Code unless otherwise noted.

Generally, the date the Form 8927 is
mailed is the date of determination
under section 860(e)(4). See Section 4 of
Rev. Proc. 2008-XX for details.

Purpose of Form
File Form 8927 to make a determination
under section 860(e)(4). When properly
completed and filed with the Internal
Revenue Service, Form 8927 will be
treated as a statement by the taxpayer
attached to its amendment or
supplement to a return of tax for the
relevant tax year for purposes of section
860(e)(4). See Rev. Proc. 2008-XX for
more information.

Specific Instructions

Who Must File

If the RIC or REIT receives its mail in
care of a third party (such as an
accountant or an attorney), enter on the
street address line “C/O” followed by the
third party’s name and street address or
P.O. box.

A RIC or REIT that seeks to make a
self-determination under section
860(e)(4) must complete and file the
Form 8927 with the Internal Revenue
Service.

Where To File
File Form 8927 with Internal Revenue
Service, Submissions Processing Center,
P.O. Box 9941, Mail Stop 4912, Ogden,
UT 84409.

When To File
File Form 8927 when the RIC or REIT
seeks to make a self-determination
under section 860(e)(4).

Name and Address
Enter the name and address of the RIC
or REIT that is filing the Form 8927. If
the post office does not deliver mail to
the street address and the corporation
has a P.O. box, show the number
instead.

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.

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 37740X

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 contents
may become material in the
administration of any Internal Revenue
law. Generally, tax returns and return
information are confidential, as required
by section 6103.
The time needed to complete and file
this form will vary depending on
individual circumstances. The estimated
average time is:
Recordkeeping

XX hr., XX min.

Learning about the law
or the form

XX hr., XX min.

Preparing, copying,
assembling, and sending
the form to the IRS

XX hr., XX min.

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 the Internal
Revenue Service; Tax Products
Coordinating Committee;
SE:W:CAR:MP:T:T:SP; 1111 Constitution
Ave., N.W.; IR-6526; Washington, DC
20224. Do not send the tax form to this
office. Instead, see “Where To File.”

Form

8927

(10-2008)