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Form 8283 (Rev. 12 -2006)
<br />Name(s) shown on your income tax return
<br />Page 2
<br />Identifying number
<br />Section B. Donated Property Over$5,000 (Except Certain Publicly Traded Securities) —List in this section only i ems (or groups of similar
<br />items) for which you claimed a deduction of more than $5,000 per item or group (except contributions of certain publicly traded
<br />securities reported in Section A). An appraisal is generally required for property listed in Section B (see instructions).
<br />Information on Donated Property—To be completed by the taxpayer and /or the appraiser.
<br />4 Check the box that describes the type of property donated:
<br />❑ Art* (contribution of $20,000 or more) ❑ Qualified Conservation Contribution ❑ Equipment
<br />❑ Art' (contribution of less than $20,000) ❑ Other Real Estate ❑ Securities
<br />❑ Collectibles" ❑ Intellectual Property ❑ Other
<br />'Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and
<br />other similar objects.
<br />"Collectibles include coins, stamps, books, gems, jewelry, sports memorabilia, dolls, etc., but not art as defined above.
<br />Note. In certain cases, you must attach a qualified appraisal of the property. See instructions.
<br />5 (a) Description of donated property (if you need
<br />more space, attach a separate statement)
<br />(b) If tangible property was donated, give a brief summary of the overall
<br />physical condition of the property at the time of the gift
<br />(c) Appraised fair
<br />market value
<br />A
<br />B
<br />C
<br />D
<br />(d) Date acquired
<br />by donor (mo., yr.)
<br />(e) How acquired
<br />by donor
<br />(f) Donor's cost or
<br />adjusted basis
<br />(g) For bargain sales, enter
<br />amount received
<br />See ins ructions
<br />(h) Amount claimed as a
<br />deduction
<br />(i) Average trading price
<br />of securities
<br />A
<br />B
<br />C
<br />D
<br />Part 11
<br />Taxpayer (Donor) Statement —List each item included in Part I above that the appraisal identifies as having
<br />a value of $500 or less. See instructions.
<br />I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500
<br />(per item). Enter identifying letter from Part 1 and describe the specific item. See instructions ►
<br />Signature of taxpayer (donor) ►
<br />Part 111
<br />Date ■
<br />Declaration of Appraiser
<br />declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or
<br />married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of my
<br />appraisals during my tax year for other persons.
<br />Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications as described in the
<br />appraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based on a percentage of the appraised property
<br />value. Furthermore, I understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to
<br />the penalty under section 6701(a) (aiding and abetting the understatement of tax liability). In addition, I understand that a substantial or gross valuation misstatement
<br />resulting from the appraisal of the value of the property that I know, or reasonably should know, would be used in connection with a return or claim for refund, may subject
<br />me to the penalty under section 6695A. I affirm that I have not been barred from presenting evidence or testimony by the Office of Professional Responsibility.
<br />Sign
<br />Here Signature ► Title ► Date ►
<br />Business address (including room or suite no.)
<br />Identifying number
<br />City or town, state, and ZIP code
<br />Part IV
<br />Donee Acknowledgment —To be completed by the charitable organization.
<br />This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described
<br />in Section B, Part 1, above on the following date ►
<br />Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part! (or any
<br />portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that
<br />form. This acknowledgment does not represent agreement with the claimed fair market value.
<br />Does the organization intend to use the property for an unrelated use? I. ❑ Yes ❑ No
<br />Name of charitable organization (donee)
<br />Employer identification number
<br />Address (number, street, and room or suite no.)
<br />City or town, state, and ZIP code
<br />Authorized signature
<br />Title
<br />Date
<br />® Printe - 7 /chic Paper Form 8283 (Rev. 12 -2006)
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