Notice of Qualified Equity Investment for 
Form  8874-A
(Rev. December 2011)                             New Markets Credit                                                                            OMB No. 1545-2065
Department of the Treasury  
Internal Revenue Service 
1     Name of qualified community development entity (CDE)       2 EIN of qualified CDE 

3     If applicable, name of parent taxpayer with whom CDE files 4 If applicable, EIN of parent taxpayer with whom CDE files  
      a consolidated tax return                                    a consolidated tax return 

5     Name of taxpayer making qualified equity investment        6 TIN of taxpayer making qualified equity investment 

7     Date of qualified equity investment (mm/dd/yyyy)           8 Amount of qualified equity investment 

9     Total allowable credit

10a   Allowable credit: Year 1 

b     Allowable credit: Year 2 

c     Allowable credit: Year 3 

d     Allowable credit: Year 4 

e     Allowable credit: Year 5 

f     Allowable credit: Year 6 

g     Allowable credit: Year 7 

         Under penalties of perjury, I declare that the qualified equity investment identified above was received by the CDE identified above. 
Please  ▲
Sign     Signature of authorized official of CDE                                   Date 
Here 
         Type or print name 
For Paperwork Reduction Act Notice, see instructions.              Cat. No. 49311G           Form  8874-A  (Rev. 12-2011) 

Form 8874-A (Rev. 12-2011)                                                                                     Page  2 

General Instructions                                       Paperwork Reduction Act Notice 
Section references are to the Internal Revenue Code        We ask for the information on this form to carry out the  
unless otherwise noted.                                    Internal Revenue laws of the United States. You are  
                                                           required to give us the information. We need it to ensure 
Purpose of Form                                            that you are complying with these laws and to allow us to 
CDEs must provide notice to any taxpayer who acquires      figure and collect the right amount of tax. 
a qualified equity investment in the CDE at its original   You are not required to provide the information  
issue that the equity investment is a qualified equity     requested on a form that is subject to the Paperwork  
investment entitling the taxpayer to claim the new         Reduction Act unless the form displays a valid OMB  
markets credit. This form is used to make the notification control number. Books or records relating to a form or its 
as required under Regulations section 1.45D-1(g)(2)(i)(A). instructions must be retained as long as their contents 
                                                           may become material in the administration of any Internal 
Where To File                                              Revenue law. Generally, tax returns and return 
Department of the Treasury                                 information are confidential, as required by section 6103. 
Internal Revenue Service Center                            The time needed to complete and file this form will vary 
Philadelphia, PA 19255-0549                                depending on individual circumstances. The estimated 
When To File                                               average time is: 
                                                           Recordkeeping    . . . . . . . . . .         4 hr., 32 min.
The original signed form must be provided by the CDE to 
the taxpayer no later than 60 days after the date the      Learning about the   
taxpayer makes the investment in the CDE. Send a copy      law or the form  . . . . . . . . . . . .         24 min. 
of the form to the IRS at the address listed above. Keep a Preparing and sending   
copy for your records.                                     the form to the IRS  . . . . . . . . . .         28 min. 
A separate form must be provided for each qualified        If you have comments concerning the accuracy of 
equity investment.                                         these time estimates or suggestions for making this form 
                                                           simpler, we would be happy to hear from you. You can 
Additional Information                                     email us at: taxforms@irs.gov. Enter “Form 8874-A 
For more details, see Form 8874, New Markets Credit,       Comment” on the subject line. Or write to: Internal 
section 45D, Regulations section 1.45D-1, and              Revenue Service, Tax Products Coordinating Committee, 
www.cdfifund.gov.                                          SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW, 
                                                           IR-6526, Washington, DC 20224. Do not send the form to 
                                                           this address. Instead, see Where To File above.