Form 8935 Airplane Payments Report

4444

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

1 Total payments

OMB No. 1545-2140

$
Form

8935

Airline Payments
Report

(March 2009)
PAYER’S federal identification no.

RECIPIENT’S identification number

RECIPIENT’S name

Year

Amount

2a

2b

3a

$
3b

Street address (including apt. no.)

4a

$
4b

City, state, and ZIP code

5a

$
5b
$
6b

6a

$
Form

8935

(3-2009)

Cat. No. 37750T

Do Not Cut or Separate Forms on This Page

—

Copy A
For
Internal Revenue
Service Center

For Privacy Act
and Paperwork
Reduction Act
Notice, see
the separate
Instructions for
Form 8935
(March 2009).

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.

1 Total payments

OMB No. 1545-2140

$
Form

8935

Airline Payments
Report

(March 2009)
PAYER’S federal identification no.

RECIPIENT’S name

RECIPIENT’S identification number

Year

Amount

2a

2b

3a

$
3b

Street address (including apt. no.)

4a

$
4b

City, state, and ZIP code

5a

$
5b

Copy B
For Recipient
This is important
tax information
and is being
furnished to the
Internal Revenue
Service.

$
6a

6b
$

Form

8935

(3-2009)

(keep for your records)

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
The information on Form 8935 is submitted to the
Internal Revenue Service by the commercial passenger
airline carrier to report payment(s) made to you under
an order of a Federal bankruptcy court in a case filed
after September 11, 2001, and before January 1, 2007,
for your interest in a bankruptcy claim against the
carrier, any note of the carrier (or amount paid in lieu
of a note being issued), or any other fixed obligation of
the carrier to pay a lump sum amount.
You received the payment(s) shown on this form
because you are a current or former employee of a
commercial passenger airline carrier and you
participated in the carrier’s defined benefit plan which
was terminated or became subject to certain
restrictions.

You can contribute the payment(s) reported on this
form to a Roth IRA within 180 days of the date you
received the payment or before June 23, 2009,
whichever is later. See chapter 2 of Pub. 590 for more
information.
Box 1. Shows the amount you received that can be
contributed to a Roth IRA.
Boxes 2a-6a. Shows each year in which you received
payments.
Boxes 2b-6b. Shows the amount you received each
year.

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

1 Total payments

OMB No. 1545-2140

$
Form

8935

Airline Payments
Report

(March 2009)
PAYER’S federal identification no.

RECIPIENT’S name

RECIPIENT’S identification number

Year
2a

Amount
2b

3a

$
3b

Street address (including apt. no.)

4a

$
4b

City, state, and ZIP code

5a

$
5b

6a

$
6b

Copy C
For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see
the separate
Instructions for
Form 8935
(March 2009).

$
Form

8935

(3-2009)

Department of the Treasury - Internal Revenue Service

Instructions for Payers
What’s new. This form is used to provide information
to current and former employees to whom you made
payments of any money or other property for certain
claims made in certain bankruptcy proceedings.
Specific form instructions are provided as a separate
product. You should use the Instructions for Form
8935 (March 2009), to complete this form. To order
these instructions and additional forms, visit the IRS
website at www.irs.gov or call 1-800-TAX-FORM
(1-800-829-3676).
Due dates. Furnish Copy B of this form to the
recipient within 90 days of payment, or, if later, by
March 23, 2009.

File Copy A of this form with the Internal Revenue
Service within 90 days of payment, or, if later, by
March 23, 2009. If you file electronically, you must
have software that generates a file according to the
specifications in Announcement 2009-7, 2009-10
I.R.B., Update and Correction to Pub. 1220,
Specifications for Filing Forms 1098, 1099, 5498, and
W-2G Electronically, containing formatting information
for Form 8935. IRS does not provide a fill-in form
option.
Need help? If you have questions about reporting on
Form 8935, call the information reporting customer
service site toll free at 1-866-455-7438 or
304-263-8700 (not toll free). For TTY/TDD equipment,
call 304-579-4827 (not toll free).