Instructions For Form 8921 (2007) - Internal Revenue Service (Page 4 of 4) in pdf

on line 18b, and specify the youngest and oldest insured for

Paperwork Reduction Act Notice. You are not required to

each contract form on line 18c.

provide the information requested on a form that is subject to

Lines 19a and 19b. Enter on line 19a the number of insureds

the Paperwork Reduction Act unless the form displays a valid

that are donors to your organization. On line 19b, enter the

OMB control number. Books or records relating to a form or its

aggregate value of the donations received by your organization

instructions must be retained as long as their contents may

from individuals insured under each contract form. These

become material in the administration of any Internal Revenue

values are those applicable to the calendar year most recently

law. Generally, tax returns and return information are

completed prior to the structured transaction date (reported on

confidential, as required by section 6103.

line 1).

The time needed to complete and file these forms will vary

Line 20. Attach a detailed description of the structured

depending on individual circumstances, such as the complexity

transaction. Your description must:

of the section 6050V structured transaction and the number of

•

State all material facts that are relevant to understanding the

individuals insured under the applicable insurance contracts.

structure, economic benefits, and tax consequences of the

The estimated burden of applicable exempt organizations filing

structured transaction;

these forms is approved under the OMB control number

•

Identify the owners and beneficiaries of the applicable

1545-2083 and is shown below.

insurance contracts;

•

Describe the nature of the cash flows among parties

Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . 33 hrs., 43 min.

Learning about the law or the form . . . . . . . . . . .

47 min.

described on lines 8a through 8l, and between such parties and

Preparing, copying, assembling, and sending the

your organization, including the methods used to allocate

form to the IRS . . . . . . . . . . . . . . . . . . . . . . . . . .

1 hr., 22 min.

earnings and insurance benefits;

•

Identify recipients or payers of any residual surplus or deficit

If you have comments concerning the accuracy of these time

amounts; and

estimates or suggestions for making this form simpler, we

•

If interest rates are fixed by contract, provide the specific

would be happy to hear from you. You can write to the

rates and terms, and if variable, identify the index(es) and

Department of the Treasury, Internal Revenue Service, Tax

spread(s).

Products Coordinating Committee, SE:W:CAR:MP:T:T:SP,

Line 21. Attach copies of related documents, including

1111 Constitution Ave. NW, IR-6526, Washington, DC 20224.

representative copies of applicable insurance contracts issued

Do not send the form to this address. Instead, see When and

as part of the structured transaction for which this Form 8921 is

Where to File on page 1.

being filed. Also include any contracts governing the obligations

of persons described on line 8a and any agreements covering

the relationship of your organization to such persons. Include

promotional materials (including financial projections) provided

to your organization, to your donors, or to other persons who

have directly or indirectly held an interest in the applicable

insurance contracts.

Part IV. Signature

An authorized individual must sign and date the Form 8921 for

your organization. Enter that individual’s name, title, and

telephone number in the spaces provided.

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Instructions For Form 8921 (2007) - Internal Revenue Service Page 4

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