Form 8924 - Excise Tax On Certain Transfers Of Qualifying Geothermal Or Mineral Interests
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1
28924
Excise Tax on Certain Transfers of Qualifying
Form
OMB No. 1545-2099
Geothermal or Mineral Interests
(Rev. January 2011)
Department of the Treasury
Internal Revenue Service
Name of entity
Employer identification number
Number, street, and room or suite no. (If a P.O. box, see instructions)
City or town, state, and ZIP code
Tax Computation
1
Date of sale or other disposition (MM/DD/YYYY) .
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2
If the property was sold or exchanged, enter the sales price of the interest transferred. If the
property was leased, enter the income realized as a result of the transfer .
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2
3
Cost or other basis of interest transferred. Enter -0- if the property was leased .
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3
4
Gain or income realized. Subtract line 3 from line 2. If zero or less, enter -0- .
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4
5
5
Fair market value of the interest transferred as of the date shown on line 1
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6
Multiply line 5 by 20% (.20) .
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6
7
Multiply line 4 by 35% (.35) .
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7
8
Tax. Add lines 6 and 7
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8
9
Tax paid with Form 7004 .
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9
10
Tax due. Enter the excess, if any, of line 8 over line 9
10
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11
Overpayment. Enter the excess, if any, of line 9 over line 8
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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
Sign
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here
Your signature
Date
Title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm's EIN
Firm's name
Use Only
▶
▶
Phone no.
Firm's address
▶
General Instructions
When To File
• A transfer in which the previous
transferor was relieved of liability for the
File Form 8924 by the later of June 30,
Section references are to the Internal
Form 8924 tax.
2011, or the 90th day following the taxable
Revenue Code.
Relief from liability. An eligible entity is
transfer. If you need more time to file, use
Purpose of Form
not required to file Form 8924 if:
Form 7004, Application for Automatic 6-
• The transferee is an eligible entity which
Month Extension of Time To File Certain
Use Form 8924 to report and pay the
provides the transferor with a qualifying
Business Income Tax, Information, and
excise tax on certain transfers of qualifying
letter of intent at the time of the transfer,
Other Returns, by the due date of Form
geothermal or mineral interests.
8924. Form 7004 does not extend the time
• The transferee is not an eligible entity but
Who Must File
for payment of tax.
establishes to the satisfaction of the
Amended Return
Secretary of the Treasury that the transfer
An eligible entity who subsequently
of ownership or possession will be
transfers ownership or possession (by sale,
To amend a previously filed Form 8924, file
consistent with section 170(h)(5) and
exchange, or lease) of a qualifying mineral
a corrected Form 8924 and write
provides the transferor with a qualifying
or geothermal interest must file Form 8924
“Amended” at the top of the form.
letter of intent at the time of the transfer, or
for each transfer of an interest acquired,
directly or indirectly, in:
• Form 8924 tax has previously been paid
as a result of a previous transfer of
• A conservation sale in which the previous
ownership or possession of the same
transferor excluded 25% of the qualifying
interest.
gain, or
8924
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 1-2011)
Cat. No. 37736P
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