Form 8613 - Return Of Excise Tax On Undistributed Income Of Regulated Investment Companies

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8613
Return of Excise Tax on Undistributed Income of
Form
Regulated Investment Companies
OMB No. 1545-1016
(Rev. March 2012)
For calendar year 20
Department of the Treasury
Internal Revenue Service
See instructions.
Name of fund
Employer identification number
Please
Type
Number, street, and room or suite no. (If a P.O. box, see instructions.)
or
Print
City or town, state, and ZIP code
• Election under section 4982(e)(4)—Check this box if the tax year of the regulated investment company ends in November or
December and the fund elects to substitute its tax year for the 1-year period ending on October 31 (see
instructions)
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1 a Investment company taxable income under section 852(b)(2) for
the calendar year determined without regard to the dividends
paid deduction and any gain or (loss) from the sale or exchange
of a capital asset (see instructions) .
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1a
b Multiply line 1a by 98% (.98) .
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1b
2 a Capital gain net income under section 4982(e)(2) for the 1-year
period ending on October 31 of the calendar year (see
instructions) .
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2a
b Multiply line 2a by 98.2% (.982) .
2b
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3 a Grossed up required distribution for the previous calendar year.
Add lines 1a and 2a (using amounts for the previous calendar
year) increased by the prior year’s shortfall (if any), as defined in
section 4982(b)(2)
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3a
b Distributed amount for the previous calendar year under section
4982(c) .
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3b
c Subtract line 3b from line 3a. If zero or less, enter -0-
3c
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4
Required distribution. Add lines 1b, 2b, and 3c .
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4
5
Deduction for dividends paid under section 561 during the calendar year, excluding exempt-
interest dividends (see instructions). Include deficiency dividends as defined in section 860(f),
but only if paid during the calendar year .
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5
6
Amount on which tax is imposed under sections 852(b)(1) or 852(b)(3)(A) for any tax year
ending in or with the calendar year (see instructions) .
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6
7 a Distributed amount for the previous calendar year under section
4982(c). Enter amount from line 3b .
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7a
b Grossed up required distribution for the previous calendar year.
Enter amount from line 3a
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7b
c Subtract line 7b from line 7a. If zero or less, enter -0-
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7c
8
Distributed amount. Add lines 5, 6, and 7c .
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8
9
Undistributed income. Subtract line 8 from line 4. If zero or less, enter -0-
9
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10
Excise tax on undistributed income. Multiply line 9 by 4% (.04)
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10
11
Tax paid with extension of time to file (Form 7004)
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11
12
Tax due. Subtract line 11 from line 10 (see instructions) .
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12
13
Overpayment. Subtract line 10 from line 11
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13
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 any knowledge.
Title
Signature of officer
Date
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
Firm's address
Phone no.
8613
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 03-2012)
Cat. No. 63985M

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