Form 1098-C - Contributions Of Motor Vehicles, Boats, And Airplanes - 2012 Page 6

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VOID
CORRECTED
OMB No. 1545-1959
DONEE’S name, street address, city, state, ZIP code, and telephone no.
Contributions of
2012
Motor Vehicles,
Boats, and
1 Date of contribution
Airplanes
1098-C
Form
2a Year
2b Make
2c Model
DONEE’S federal identification
DONOR’S identification
3 Vehicle or other identification number
number
number
DONOR’S name
4a
Donee certifies that vehicle was sold in arm’s
length transaction to unrelated party
Street address (including apt. no.)
4b Date of sale
Copy D
4c Gross proceeds from sale (see instructions)
City, state, and ZIP code
For Donee
$
5a
Donee certifies that vehicle will not be transferred for money, other property, or services before completion of material
improvements or significant intervening use
For Privacy Act
5b
Donee certifies that vehicle is to be transferred to a needy individual for significantly below fair market value in furtherance of
and Paperwork
donee’s charitable purpose
Reduction Act
Notice, see the
5c Donee certifies the following detailed description of material improvements or significant intervening use and duration of use
2012 General
Instructions for
Certain
Information
Returns.
6a Did you provide goods or services in exchange for the vehicle? .
Yes
No
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6b Value of goods and services provided in exchange for the vehicle
$
6c Describe the goods and services, if any, that were provided. If this box is checked, donee certifies that the goods and services
consisted solely of intangible religious benefits .
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7 Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked .
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1098-C
Form
Department of the Treasury - Internal Revenue Service

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