Form  8283-V                                                       Payment Voucher for Filing Fee Under 
(August 2013)                                                              Section 170(f)(13)                                                                           OMB No. 1545-2069
Department of the Treasury  
Internal Revenue Service 
What Is Form 8283-V and Do You Have To                                                 • Do not staple or otherwise attach your payment or Form 8283-V to  
                                                                                       each other. Instead, just put them loose in an envelope. 
Use It?                                                                                • Do not mail Form 8283-V with your return. Instead, mail Form 8283-V 
It is a statement you send with your check or money order to pay the                   and your payment, at the same time you file your return, to: 
$500 filing fee that is required if you claim a deduction of more than  
$10,000 for a charitable contribution of an easement on the exterior of a                           Internal Revenue Service  
building in a registered historic district.                                                         P.O. Box 9002   
                                                                                                    Beckley, WV 25802-9002 
A separate $500 filing fee is required for each contribution of this type. If 
you do not pay the fee, your deduction will not be allowed. You may 
choose to pay the fee electronically. If you do, you do not need to send               Paperwork Reduction Act Notice. We ask for the information on Form 
in Form 8283-V. To find out how to pay electronically, go to www.irs.gov               8283-V to help us carry out the Internal Revenue laws of the United 
and enter “electronic payment of user fees” in the search box.                         States. We need it to ensure you are complying with these laws and to 
                                                                                       allow us to figure and collect the right amount of tax. Section 170(f)(13) 
How To Fill In Form 8283-V                                                             of the Internal Revenue Code provides that no deduction is allowed for 
Line 1. Individuals must enter their social security number (SSN). All                 the type of charitable contribution described in these instructions unless 
other filers must enter their employer identification number (EIN).                    a $500 filing fee is paid. 
Line 2. Enter the tax year when the contribution was made. Fiscal year                 You are not required to provide the information requested on a form 
filers, enter the dates your fiscal year began and ended.                              that is subject to the Paperwork Reduction Act unless the form displays 
                                                                                       a valid OMB control number. Books or records relating to a  form or its 
Line 3. Enter the number of contributions made during the year for                     instructions must be retained as long as their contents may become 
which you must pay the $500 filing fee.                                                material in the administration of any Internal Revenue law. Generally, tax 
Line 4. Multiply the number on line 3 by $500 and enter the result.                    returns and return information are confidential, as required by Internal 
Line 5. Check the box for the type of return on which the charitable                   Revenue Code section 6103. 
contribution deduction is being claimed.                                               The average time and expenses required to complete and file this  
Line 6. Enter your name and address as shown on your return.                           form will vary depending on individual circumstances. The estimated  
                                                                                       average time is: 
How To Prepare Your Payment                                                            Learning about the law   
Pay the amount shown on line 4. Make your check or money order                         or the form             . .  . .               .    .                 . . . . .  .    .  .   . 23   min. 
payable to “United States Treasury.” Do not send cash.                                 Preparing the form           . .               .    .                 . . . . .  .    .  .   .   12 min. 
Enter “Form 8283-V,” the tax year, and your identifying number on                      If you have comments concerning the accuracy of these time  
your check or money order. Make sure your name and address appear                      estimates or suggestions for making this form simpler, we would be  
on your payment.                                                                       happy to hear from you. See the instructions for your income tax return. 
How and When To Send In Your Filing Fee  
Payment and Form 8283-V 
• Detach Form 8283-V along the dotted line. 

                                                                                    Cat. No. 49169U                                                                     Form 8283-V (8-2013) 

                                                                     ▼  Detach Here and Mail With Your Payment  ▼

Form  8283-V                                                       Payment Voucher for Filing Fee Under 
(August 2013)                                                              Section 170(f)(13)                                                                           OMB No. 1545-2069
Department of the Treasury                                         ▶   Make your check or money order payable to "United States Treasury." 
Internal Revenue Service                                            ▶  Do not staple or attach this voucher to your payment or return.
                            1  Identifying number                       2  Tax Year 3  Number of properties                                                    4 Amount you are paying by  
                                                                                                 requiring fee                                                       check or money order
                                                                                                                   X  $500.00 =                                      Dollars             Cents
                            5  Type of Return Filed 
                                           1040             1065           1120        1120S                        Other   ▶
                            6  Name(s) shown on your return                                                                                                    Daytime phone number 

              Print or type Address (number, street, and apt. no.) 

                            City, town or post office, state, and ZIP code. (If a foreign address, enter city, province or state, postal code, and country.)