Form 8612 - Return Of Excise Tax On Undistributed Income Of Real Estate Investment Trusts

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8612

Return of Excise Tax on Undistributed Income of

Form

Real Estate Investment Trusts

OMB No. 1545-1013

(Rev. November 2016)

For calendar year 20

Department of the Treasury

Information about Form 8612 and its instructions is at

Internal Revenue Service

▶

Name of REIT

Employer identification number

Please

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

Type

City or town, state, and ZIP code

1 a

Taxable income under section 857(b)(2) for the calendar year.

See instructions .

Multiply line 1a by 85% (0.85) .

2 a

Capital gain net income under section 4981(e)(2) for the calendar

year. See instructions

Multiply line 2a by 95% (0.95) .

3 a

Grossed up required distribution for the previous calendar year.

See instructions .

Distributed amount for the previous calendar year under section

4981(c) .

Subtract line 3b from line 3a. If zero or less, enter -0-

Required distribution. Add lines 1b, 2b, and 3c .

Deduction for dividends paid under section 561 during the calendar year. See instructions .

Amount on which tax is imposed under sections 857(b)(1) or (b)(3)(A) for any tax year ending in or

with the calendar year. See instructions .

7 a

Distributed amount for the previous calendar year under section

4981(c). Enter amount from line 3b above .

Grossed up required distribution for the previous calendar year.

Enter amount from line 3a above .

Subtract line 7b from line 7a. If zero or less, enter -0-

Distributed amount. Add lines 5, 6, and 7c

Undistributed income. Subtract line 8 from line 4. If zero or less, enter -0- .

Excise tax on undistributed income. Multiply line 9 by 4% (0.04) .

Tax paid with extension of time to file (Form 7004)

Tax due. Subtract line 11 from line 10. See instructions .

Overpayment. Subtract line 10 from line 11

Under penalties of perjury, I declare that I have examined this return, 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

Sign

any knowledge.

Here

Date

Title

Signature of officer

Print/Type preparer’s name

Preparer’s signature

Date

PTIN

Paid

Check