965 B Corporate and Real Estate Investment Trust (REIT) Report

Form

965-B

Corporate and Real Estate Investment Trust (REIT) Report of Net 965
Tax Liability and Electing REIT Report of 965 Amounts

(January 2019)
Department of the Treasury
Internal Revenue Service

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Check this box if this is an amended report

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OMB No. 1545-0123

Go to www.irs.gov/Form965B for instructions and the latest information.

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Identifying number

Name of taxpayer or REIT

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Taxable year of reporting

REITs Electing To Account for Section 965 Amounts Over Time Must Fill Out Part III.

Part I

Report of Net 965 Tax Liability and Election To Pay in Installments

(a)
Year of
Section
965(a)
Inclusion or
Liability
Assumed

(b)
Taxpayer’s Net Tax Liability
with all
965 amounts
(see instructions)

(c)
Taxpayer’s Net Tax Liability
without
965 amounts
(see instructions)

(d)
Net 965 Tax Liability
(subtract column (c)
from column (b))

(e)
Installment
Election
Made

(see instructions)

Yes

(f)
Net 965 Tax Liability
to be paid in full in Year 1
(if column (e) is “No,” enter
amount from column (d))

(g)
Net 965 Tax Liability
to be paid in installments
(if column (e) is “Yes,” enter
amount from column (d)
and see instructions)

No

(h)
Net 965 Tax Liability
Transferred (Out),
Transferred In, or
Subsequent Adjustments,
if any (see instructions)

(i)
Tax
Identification
Number
of buyer/
transferee or
seller/
transferor

1
2
3
4
5
6
7

Part II

Record of Amount of Net 965 Tax Liability Paid by the Taxpayer (see instructions)

(a)
Year of Section 965(a)
Inclusion or
Liability Assumed
(see instructions)

(b)
Paid for Year 1

(c)
Paid for Year 2

(d)
Paid for Year 3

(e)
Paid for Year 4

(f)
Paid for Year 5

1
2
3
4
5
6
7
(g)
Paid for Year 6

(h)
Paid for Year 7

(j)
Net 965 Tax Liability
Remaining Unpaid (see instructions)

(i)
Paid for Year 8

(k)
Net 965 Tax Liability
Paid for the Reporting Year

1
2
3
4
5
6
7
Totals .

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

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Cat. No. 71278S

Form 965-B (1-2019)

Page 2

Form 965-B (1-2019)

Part III

Electing REIT Report of Section 965 Amounts Accounted for Over Time (see instructions)
(a)
Tax Year of
Section 965(a) Inclusion and
Section 965(c) Deduction

(b)
Amount Elected to be
Accounted for Over Time

(c)
Portion Accounted for in
Year 1

(d)
Portion Accounted for in
Year 2

(e)
Portion Accounted for in
Year 3

(f)
Portion Accounted for in
Year 4

(g)
Portion Accounted for in
Year 5

(h)
Portion Accounted for in
Year 6

(i)
Portion Accounted for in
Year 7

(j)
Portion Accounted for in
Year 8

(k)
Amount Remaining to be
Accounted for

(l)
Portion Accounted for
in this Reporting Year

1a
1b
2a
2b
3a
3b

1a
1b
2a
2b
3a
3b
Totals . . . . . . . . . . . . . . . . . . . . . . . .
If more lines are needed for any Parts on this form, attach additional sheets.

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Form 965-B (1-2019)