Form 8804-C - Certificate Of Partner-Level Items To Reduce Section 1446 Withholding Page 3
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Form 8804-C (Rev. 3-2009)
Page
9
I have not used (and will not use) any of the deductions and losses set forth in this certificate to reduce installment tax
obligations under section 6654 or 6655 on income, other than my allocable share of income from the partnership to which
this certificate is provided.
10
The amounts of deductions and losses set forth in this Form 8804-C have not been certified to another partnership for the same
tax year for the purpose of reducing that other partnership’s withholding under section 1446.
11
The deductions and losses set forth in this certificate have not been disallowed by the IRS as part of a proposed adjustment
described in Regulations section 601.103(b) or 601.105(b).
Part III
Certification Under Regulations section 1.1446-6(c)(1)(ii)
Complete Part III to certify that your investment in the partnership is (and will be) your only activity that will give rise to effectively
connected items for the tax year (see instructions).
Whereas the partner has provided all of the applicable information requested in Part I of this form, which is incorporated into this
certification by reference, the partner represents:
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If the only activity that gives rise to effectively connected income, gain, deduction, or loss during the partner’s tax year is (and
will be) the partner’s investment in the partnership, check here
Part IV
Disclosure Consent and Signature
Consent is hereby given to disclosures of return and return information by the Internal Revenue Service pertaining to the validity
of this certificate to the partnership or other withholding agent to which this certificate is submitted for the purpose of administering
section 1446.
Under penalties of perjury, I declare that I have examined this certification, including accompanying schedules and statements, and
to the best of my knowledge and belief, it is true, correct, and complete.
Title
Date
Sign
Here
Signature of partner or authorized representative
If signed by an authorized representative, a copy of the power of attorney must be attached.
8804-C
Form
(Rev. 3-2009)
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