Form 976 Claim for Deficiency Dividends Deductions by a Personal

Form

976

Claim for Deficiency Dividends Deductions by a
Personal Holding Company, Regulated Investment
Company, or Real Estate Investment Trust

(Rev. December 2012)
Department of the Treasury
Internal Revenue Service
Name of entity

OMB No. 1545-0045

(Under Section 547 or 860 of the Internal Revenue Code)

Employer identification number
Type of entity filing the claim:

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

Personal holding company
City or town, state, and ZIP code

Regulated investment company
Real estate investment trust

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2
3a
b
4
5
a
b

c
d
e
f

Amount of tax deficiency . . . . . . . . . . .
Tax year of deficiency ends:
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Amount paid . . . . . . . . . . . . . . .
Date paid
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Amount unpaid. Subtract line 3a from line 1 . . . .
How was the deficiency established?
Tax Court Decision—Attach a copy.
Court Judgment—Attach a copy. If established by a
United States for refund:

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3a

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4

final judgment in a suit against the

(1) Date the claim for refund was filed
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(2) Date the suit was brought
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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.
If a regulated investment company or real estate investment trust, a statement under
section 860(e)(4)—Attach a copy of the Form 8927 filed with the IRS (see instructions).

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Determination date (see instructions)
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Date the deficiency dividend was distributed
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resolution of the board of directors or other authority authorizing the payment of the deficiency dividend.)
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Deficiency dividend was distributed as follows:
a Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Other property (attach description):
(1) Fair market value . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Adjusted basis . . . . . . . . . . . . . . . . . . . . . . . . . .
9a Amount claimed as a deduction for deficiency dividends . . . . . . . . . . . .
b For a regulated investment company or real estate investment trust, enter the amount of line
9a designated as capital gain dividends . . . . . . . . . . . . . . . . . .
10 Only personal holding companies must complete line 10.
(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

Signature of officer

Print/Type preparer’s name

Date
Preparer's signature

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Paid
Preparer
Use Only

8b(1)
8b(2)
9a
9b
(c) Amount of deficiency dividend
paid to each shareholder on each
class of stock

Under penalties of perjury, I declare that I have examined this claim, including accompanying schedules and statements, and to the best of 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.

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Sign
Here

8a

Title

Date

Check
if
self-employed

Firm’s name

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Firm's EIN

Firm's address

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Phone no.

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Cat. No. 17061B

PTIN

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Form 976 (Rev. 12-2012)

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Form 976 (Rev. 12-2012)

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

Future Developments
For the latest information about developments related to Form 976 and its
instructions, such as legislation enacted after they were published, go to
www.irs.gov/form976.
Purpose of form. File Form 976 for a personal holding company (PHC),
regulated investment company (RIC), or real estate investment trust (REIT)
that is claiming a deficiency dividend deduction under section 547 or 860. If
the claim is allowed, taxpayers will be relieved, in whole or in part, from the
payment of certain taxes (or allowed a credit or refund of certain taxes). In
addition, a RIC or REIT will owe interest determined with respect to the
amount of the deficiency dividend deduction allowed. See sections 860(a),
860(c), 6601, and 6621. The Service will notify the RIC or REIT of the amount
of interest.
When and where to file. File Form 976 within 120 days after the
determination date (defined below). A PHC must file Form 976 with the IRS
office where the determination of PHC status was made. A RIC or a REIT
must file Form 976 with the Internal Revenue Service Center where the
income tax return for the tax year for which the determination applies was
filed, unless the situations below apply.
If the determination is made by a RIC or REIT under section 860(e)(4), file
Form 976 with the Internal Revenue Service, P.O. Box 9941, Mail Stop 4912,
Ogden, UT 84409. This is the same address for filing Form 8927,
Determination Under Section 860(e)(4) by a Qualified Investment Entity.
If the determination is from an agreement with the delegate (under section
547(c)(3) or 860(e)(3)) any claim resulting from the deficiency dividend
deduction may be filed with the delegate or corresponding IRS office.
Deficiency dividends. Deficiency dividends must be distributed no later than
90 days after the determination date (defined below) and prior to filing
Form 976.
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.
Determination date. If the determination was made by:
• A decision of the Tax Court, the determination date is the date the decision
becomes final under section 7481.
• A judgment, decree, or order by a court, the determination date is the date
the judgment, decree, or order becomes final.
• A closing agreement made under section 7121, the determination date is
the date the agreement is approved by the Commissioner.
• An agreement between the IRS and the taxpayer under section 547(c)(3)
(Form 2198) (see below) 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 delegate of the Commissioner, the
determination date is the date the agreement was signed.
• A RIC or REIT under section 860(e)(4) (Form 8927), in general, the
determination date is the date Form 8927 was mailed to the IRS. See Rev.
Proc. 2009-28 for more information. A RIC or REIT should retain written
evidence with its records to establish the date Form 8927 was mailed.
Enter this date on line 6.
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 PCH to establish the PCH’s tax liability.
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.

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.
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.
Line 1. Enter the amount of the tax liability established by the determination
without taking into account the deficiency dividend deduction claimed and
without regard to whether the tax liability is (or was) a deficiency as defined
under section 6211(a)(1).
Line 2. Enter the ending date of the tax year for which the deficiency
dividend deduction is claimed. A separate Form 976 must be filed for each
deficiency dividend deduction claimed.
Line 3a. Enter the amount paid, if any, of the tax liability entered on line 1
without taking into account the deficiency dividend deduction.
Line 5f. A RIC or REIT can file Form 8927 with the IRS to make a selfdetermination. If a statement is used instead of Form 8927, attach a copy of
the statement to Form 976.
Line 6. See Determination date, earlier, for more information.
Line 8(b). If a stock distribution by a publicly traded RIC or REIT meets all
the requirements of section 3.02 of Rev. Proc. 2010-12, the RIC or REIT that
made the distribution must enter the fair market value of the stock distributed
on line 8(b)(1) and is not required to complete line 8(b)(2). See Rev. Proc.
2010-12 for more information.
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.
If an officer completed Form 976, the Paid Preparer Use Only 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 Use Only" section of the
return.
The preparer required to sign the return must complete 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) and
• Give a copy of Form 976 to the taxpayer in addition to the copy filed with
the IRS.
Paperwork Reduction Act Notice. We ask for the information on this form
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 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 content may become material in the
administration of any Internal Revenue law. Generally, tax return 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

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5 hr., 44 min.

Learning about the law or the form .

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

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. 1 hr., 2 min.

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53 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 Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send this form to this office. Instead, see
When and where to file above.