Form 8876 - Excise Tax On Structured Settlement Factoring Transactions
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28876
Excise Tax on Structured
Settlement Factoring Transactions
Form
OMB No. 1545-1826
(Rev. December 2013)
Information about Form 8876 and its instructions is at
Department of the Treasury
▶
Internal Revenue Service
Date of receipt of structured settlement payment rights .
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Name
Identifying number
Please
Number, street, and room or suite no. (If a P.O. box, see instructions.)
Type
or
Print
City or town, state or province, country, and ZIP or foreign postal code
1
Total undiscounted amount of structured settlement payments being acquired .
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1
2
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Total amount paid for the above structured settlement payment rights .
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Factoring discount. Subtract line 2 from line 1 .
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Tax. Multiply line 3 by 40% (.40)
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Less: Tax paid with Form 7004 .
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Tax due. Subtract line 5 from line 4. If zero or less, enter -0- .
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Overpayment. If line 5 is greater than line 4, subtract line 4 from line 5
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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.
Sign
Here
Title (if any)
Signature
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
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Firm's address
Phone no.
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• Established (a) by suit or agreement for the
Section references are to the Internal
• The creation or perfection of a security
Revenue Code unless otherwise noted.
periodic payment of damages excludable
interest in structured settlement payment
from the gross income of the recipient under
rights under a blanket security agreement
Future Developments
section 104(a)(2) or (b) by agreement for the
entered into with an insured depository
periodic payment of compensation under any
institution in the absence of any action to
For the latest information about developments
workers’ compensation law excludable from
redirect the structured settlement payments
related to Form 8876 and its instructions,
the gross income of the recipient under
to that institution (or agent or successor
such as legislation enacted after they were
section 104(a)(1); and
thereof) or otherwise to enforce such blanket
published, go to
security interest as against the structured
• Under which the periodic payments are (a)
General Instructions
settlement payment rights.
of the character described in section 130(c)(2)
(A) and (B) and (b) payable by a person who is
• A subsequent transfer of structured
Purpose of Form
a party to the suit or agreement or to the
settlement payment rights acquired in a
Use Form 8876 to report and pay the 40%
workers’ compensation claim or by a person
structured settlement factoring transaction.
excise tax imposed under section 5891 on the
who has assumed the liability for such
Structured settlement payment rights.
factoring discount of a structured settlement
periodic payments under a qualified
Structured settlement payment rights are
factoring transaction. File a separate Form
assignment in accordance with section 130.
rights to receive payments under a structured
8876 for each date on which you received
Structured settlement factoring
settlement.
structured settlement payment rights in one
transaction. A structured settlement
or more structured settlement factoring
Factoring discount. The factoring discount is
factoring transaction is a transfer of
transactions.
the difference between the total undiscounted
structured settlement payment rights
amount of structured settlement payments
(including portions of structured settlement
Definitions
being acquired (line 1) and the total amount
payments) made for consideration by means
paid by the acquirer to the person(s) from
Structured settlement. A structured
of sale, assignment, pledge, or other form of
whom the structured settlement payment
settlement is an arrangement:
encumbrance or alienation for consideration.
rights are acquired (line 2).
The following are not structured settlement
Qualified order. A qualified order is a final
factoring transactions.
order, judgment, or decree that:
8876
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 12-2013)
Cat. No. 33529K
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