Determination Under Section 860(E)(4) By A Qualified Investment Entity


Determination Under Section 860(e)(4) by a
Qualified Investment Entity
OMB No. 1545-0123
(Rev. December 2016)
Department of the Treasury
Information about Form 8927 and its instructions is at
Internal Revenue Service
For calendar year 20
or tax period beginning
, 20
, and ending
, 20
Employer identification number (EIN)
Name of regulated investment company (RIC) or real estate investment trust (REIT)
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
Service Center where the tax return for the year entered above was or will be filed
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete.
Signature of officer
General Instructions
Date of Determination
You are not required to provide
the information requested on a form
Generally, the date Form 8927 is
Section references are to the Internal
that is subject to the Paperwork
mailed is the date of determination
Revenue Code unless otherwise
Reduction Act unless the form
under section 860(e)(4). See Section
displays a valid OMB control
4 of Rev. Proc. 2009-28 for details.
number. Books or records relating to
Purpose of Form
a form or its instructions must be
Specific Instructions
File Form 8927 to make a
retained as long as their contents
determination under section
may become material in the
Name and Address
860(e)(4). When properly completed
administration of any Internal
Enter the name and address of the
and filed with the Internal Revenue
Revenue law. Generally, tax returns
RIC or REIT that is filing Form 8927.
Service, Form 8927 will be treated
and return information are
If the post office doesn't deliver mail
as a statement by the taxpayer
confidential, as required by section
to the street address and the
attached to its amendment or
corporation has a P.O. box, show
supplement to a return of tax for the
The time needed to complete and
the number instead.
relevant tax year for purposes of
file this form will vary depending on
section 860(e)(4). For more
If the RIC or REIT receives its mail
individual circumstances. The
information, see Rev. Proc. 2009-28,
in care of a third party (such as an
estimated burden for business
2009-20 I.R.B. 1011, available at
accountant or an attorney), enter on
taxpayers filing this form is approved
the street address line “C/O”
under OMB control number
followed by the third party’s name
1545-0123 and is included in the
and street address or P.O. box.
Who Must File
estimates shown in the instructions
for their business income tax return.
A RIC or REIT that seeks to make a
Paperwork Reduction Act
If you have comments concerning
self-determination under section
the accuracy of these time estimates
860(e)(4) must file Form 8927 with
or suggestions for making this form
the Internal Revenue Service.
We ask for the information on this
simpler, we would be happy to hear
form to carry out the Internal
Where To File
from you. You can send us comments
Revenue laws of the United States.
from Click
File Form 8927 with the Internal
You are required to give us the
on “More information” and then on
Revenue Service, P.O. Box 9941,
information. We need it to ensure
“Give us feedback.” Or you can write
Mail Stop 4912, Ogden, UT 84409.
that you are complying with these
to the Internal Revenue Service; Tax
laws and to allow us to figure and
When To File
Forms and Publications Division; 1111
collect the right amount of tax.
Constitution Ave., N.W.; IR-6526;
File Form 8927 when the RIC or REIT
Washington, DC 20224. Do not send
seeks to make a self-determination
Form 8927 to this office. Instead, see
under section 860(e)(4).
“Where To File.”
(Rev. 12-2016)
Cat. No. 37740X


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