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Form 8283 (Rev. 11-2022) Page 2
Name(s) shown on your income tax return Identifying number
Part II Partial Interests and Restricted Use Property (Other Than Qualified Conservation Contributions)—
Complete lines 4a through 4e if you gave less than an entire interest in a property listed in Section B, Part I.
Complete lines 5a through 5c if conditions were placed on a contribution listed in Section B, Part I; also
attach the required statement. See instructions.
4a Enter the letter from Section B, Part I that identifies the property for which you gave less than an entire interest
If Section B, Part II applies to more than one property, attach a separate statement.
b Total amount claimed as a deduction for the property listed in Section B, Part I: (1) For this tax year . . .
(2) For any prior tax years .
c Name and address of each organization to which any such contribution was made in a prior year (complete only if different
from the donee organization in Section B, Part V, below):
Name of charitable organization (donee)
Address (number, street, and room or suite no.) City or town, state, and ZIP code
d For tangible property, enter the place where the property is located or kept
e Name of any person, other than the donee organization, having actual possession of the property
Yes No
5a Is there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donated property?
b Did you give to anyone (other than the donee organization or another organization participating with the donee
organization in cooperative fundraising) the right to the income from the donated property or to the possession of
the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to
designate the person having such income, possession, or right to acquire? . . . . . . . . . . . . .
c Is there a restriction limiting the donated property for a particular use? . . . . . . . . . . . . . .
Part III Taxpayer (Donor) Statement—List each item included in Section B, Part I above that the appraisal identifies
as having a value of $500 or less. See instructions.
I declare that the following item(s) included in Section B, Part I above has to the best of my knowledge and belief an appraised value
of not more than $500 (per item). Enter identifying letter from Section B, Part I and describe the specific item. See instructions.
Signature of
taxpayer (donor) Date
Part IV Declaration of Appraiser
I 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
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
appraisals during my tax year for other persons.
Also, I declare that I perform appraisals on a regular basis; and that because of my qualifications as described in the 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 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 the penalty under section 6701(a) (aiding and
abetting the understatement of tax liability). I understand that my appraisal will be used in connection with a return or claim for refund. I also understand that, if there is a
substantial or gross valuation misstatement of the value of the property claimed on the return or claim for refund that is based on my appraisal, I may be subject to a penalty
under section 6695A of the Internal Revenue Code, as well as other applicable penalties. I affirm that I have not been at any time in the three-year period ending on the date
of the appraisal barred from presenting evidence or testimony before the Department of the Treasury or the Internal Revenue Service pursuant to 31 U.S.C. 330(c).
Sign Appraiser signature Date
Here Appraiser name Title
Business address (including room or suite no.) Identifying number
City or town, state, and ZIP code
Part V Donee Acknowledgment
This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property
as described in Section B, Part I, above on the following date
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section
B, Part I (or any 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 form. This acknowledgment does not represent agreement with the claimed fair market value.
Does the organization intend to use the property for an unrelated use? . . . . . . . . . . . . . . . Yes No
Name of charitable organization (donee) Employer identification number
Address (number, street, and room or suite no.) City or town, state, and ZIP code
Authorized signature Title Date
Form 8283 (Rev. 11-2022)
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