8877
Request for Waiver of Annual Income Recertification
Form
Requirement for the Low-Income Housing Credit
OMB No. 1545-1882
(Rev. January 2006)
See instructions on back.
Department of the Treasury
Note: To be used only for 100% low-income buildings.
Internal Revenue Service
Part I
Certification (Note: The building owner must also complete Part II on page 3.)
Name of building or project
Name of building owner
Street address of building or project
Street address of building owner
City, state, and ZIP code
City, state, and ZIP code
Building identification number (BIN)
Taxpayer identification number
As the building owner, I certify that:
● I am applying for the annual income recertification waiver provided for in section 42(g)(8)(B);
● Each building listed on this form, and in any attached statement, is a 100% low-income building (see Who May File on page 2 for the meaning
of 100% low-income building); and
● I have read and understand the Effects of Obtaining a Waiver in the instructions on page 2.
Under penalties of perjury, I declare that the foregoing statements and information are true, correct, and complete to the best of my knowledge
and belief.
Signature of building owner
Title
Date
Type or print name
Telephone number
Additional BINs (continue in same format on an attached statement if necessary)
Attestation and Exemption by Housing Credit Agency
As an authorized official of the housing credit agency named below, I certify that:
● The agency is responsible for the monitoring of each building to which this waiver request applies;
● Each building listed on this form, and in any attached statement, was a 100% low-income building at the end of the most recent credit year for
the building; and
● The agency exempts the building owner from annual income recertifications as provided in Rev. Proc. 2004-38, effective on the date of IRS
approval of the waiver.
Under penalties of perjury, I declare that the foregoing statements and information are true, correct, and complete to the best of my knowledge
and belief.
Name of housing credit agency
Signature of authorized official
Date
Name (please type or print)
IRS APPROVAL—IRS Use Only
Signature of authorized official
Title
Effective date of waiver
8877
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Cat. No. 32126P
Form
(Rev. 1-2006)