Form 8927 - Determination Under Section 860(E)(4) By A Qualified Investment Entity

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Determination Under Section 860(e)(4) by a
Qualified Investment Entity
(July 2009)
OMB No. 1545-2130
Department of the Treasury
See instructions.
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
You are not required to provide
General Instructions
Date of Determination
the information requested on a form
Generally, the date Form 8927 is
Section references are to the
that is subject to the Paperwork
mailed is the date of determination
Internal Revenue Code unless
Reduction Act unless the form
under section 860(e)(4). See Section
otherwise noted.
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 does not deliver
as a statement by the taxpayer
confidential, as required by
mail to the street address and the
attached to its amendment or
section 6103.
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 average time is:
2009-20 I.R.B. 1011, available at
accountant or an attorney), enter on
2 hr., 9 min.
the street address line “C/O”
followed by the third party’s name
Learning about the law
and street address or P.O. box.
Who Must File
or the form
18 min.
Preparing, copying,
A RIC or REIT that seeks to make a
assembling, and sending
self-determination under section
Paperwork Reduction Act
the form to the IRS
20 min.
860(e)(4) must file Form 8927 with
the Internal Revenue Service.
If you have comments concerning
We ask for the information on this
the accuracy of these time estimates
form to carry out the Internal
Where To File
or suggestions for making this form
Revenue laws of the United States.
File Form 8927 with the Internal
simpler, we would be happy to hear
You are required to give us the
Revenue Service, P.O. Box 9941,
from you. You can write to the
information. We need it to ensure
Mail Stop 4912, Ogden, UT 84409.
Internal Revenue Service; Tax
that you are complying with these
Products Coordinating Committee;
laws and to allow us to figure and
When To File
SE:W:CAR:MP:T:T:SP; 1111
collect the right amount of tax.
Constitution Ave., N.W.; IR-6526;
File Form 8927 when the RIC or
Washington, DC 20224. Do not send
REIT seeks to make a
Form 8927 to this office. Instead,
self-determination under
see “Where To File.”
section 860(e)(4).
Cat. No. 37740X


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