|
Form 8283 (Rev, 122006)
<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 tams (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 />❑ Ad' (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 />'An 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, hooks, gems. jewelry, sports memorabilia, dolls. etc., but not art as defined above.
<br />Note. In pertain cases, you must attach a qualified appraisal of the property. See instructions.
<br />Part t
<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 Woe 01 the gift
<br />(0) Appraised fair
<br />market value
<br />A
<br />B
<br />C
<br />D
<br />(d) Date acquired
<br />by donor (mo.. yr.)
<br />le) How acqured
<br />by donor
<br />(1) Donor's cost or
<br />adjusted basis
<br />(g) For bargain sales, enter
<br />amount received
<br />See ins ructions
<br />Ihl Amount claimed as a
<br />deduction
<br />(1) Average trading pace
<br />of securities
<br />A
<br />B
<br />C
<br />0
<br />w� Taxpayer onor ) 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 3500
<br />(per Item). Enter Identifying letter from Part 1 and describe the specific item. See instructions iv-
<br />Signature of taxpayer (donor) ►
<br />Part 111
<br />Declaration of Appraiser
<br />Date ►
<br />I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the properly, employed by, or related to any of theforegoing persons, or
<br />mauled to any person who is related to any of the foregoing parsons. 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 typo of property being valued. I catty that the appraisal fees were not based on a percentage et the appra'sed property
<br />value. Furthermore, I understand that a false or fraudulent overstatement of the properly 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 th penally under section 6695A, 1 affirm that I have not been barred from presenting evidence or testimony by the Office of Professional Responsibility.
<br />Sign
<br />Here Signature ov Tide ► Date 1
<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 properly as described
<br />in Section B, Part I, 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 8, Part I (or any
<br />portion thereof) within 3 years after the date of receipt, it will li(eForm 8282, Donee Information Return, with the IRS and give the donor acopy 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? ► ❑ Yes ❑ No
<br />Name of charitable organization (donee) 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 I Date
<br />® Porno - 7 reed Paper Form 8283 (Rev. 12 -2005)
<br />
|