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4343
Form
8935-T Transmittal of Airline Payments Reports OMB No. 1545-2140
(June 2009)
Department of the Treasury
Internal Revenue Service
1 FILER’S name 2 Employer identification number
3a Name of person to contact
Street address (including room or suite number) 3b Telephone number
()
City, state, and ZIP code 3c Email address
4 Payment date(s) 5 Total amount reported 6 Number of Forms 8935 transmitted
$
Under penalties of perjury, I declare that I have examined this transmittal and accompanying forms, and, to the best of my knowledge and belief, they are true,
correct, and complete.
Signature Title Date
Instructions Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on these forms to carry out the Internal
Purpose of form. Use Form 8935-T to transmit paper Forms Revenue laws of the United States. You are required to give
8935, Airline Payments Report, to the Internal Revenue us the information. We need it to figure and collect the right
Service. amount of tax.
Who must file. Every commercial passenger airline carrier Public Law 110-458 section 125, and Internal Revenue
that pays one or more airline payment amounts as defined in Code section 408A and its regulations, require you to file an
section 125(b)(1) of Public Law 110-458 must file information return with the IRS and furnish a statement to
Form 8935-T to transmit paper Forms 8935. recipients. Section 6109 and its regulations require you to
When to file. File Forms 8935 and 8935-T within 90 days of provide your taxpayer identification number on what you file.
the date of making the airline payment(s) to qualified current Routine uses of this information include giving it to the
and former employees. For payments made before Department of Justice for civil and criminal litigation, and to
December 24, 2008, file Forms 8935 and 8935-T by March cities, states, and the District of Columbia for use in
23, 2009. administering their tax laws. We may also disclose this
Attach all Forms 8935 to only one Form 8935-T for information to other countries under a tax treaty, to federal
payments made before December 24, 2008. For payments and state agencies to enforce federal nontax criminal laws,
made after December 23, 2008, attach Forms 8935 to only or to federal law enforcement and intelligence agencies to
one Form 8935-T per payment date. You can attach Forms combat terrorism. If you fail to provide this information in a
8935 for more than one payment date as long as all payment timely manner, you may be subject to penalties.
dates are within 90 days of the filing date. You are not required to provide the information requested
Where to file. Send Form 8935-T with attachments to: on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
Department of the Treasury or records relating to a form or its instructions must be
Internal Revenue Service Center retained as long as their contents may become material in
Kansas City, MO 64999 the administration of any Internal Revenue law. Generally, tax
Boxes 1 and 2. Enter the name, address, and employer returns and return information are confidential, as required by
identification number (EIN) of the carrier or other filer of this section 6103.
form. The time needed to complete and file this form will vary
Boxes 3a, 3b, and 3c. Enter the name, telephone number, depending on individual circumstances. The estimated
and email address of the person at the airline carrier who can average time is:
be contacted for more information. Learning about the law or the form 10 min.
Box 4. Enter the date(s) the payments were made. Preparing the form 15 min.
Box 5. Enter the total amount(s) paid as reported on the If you have comments concerning the accuracy of these
attached Form(s) 8935. time estimates or suggestions for making this form simpler,
Box 6. Enter the number of Forms 8935 being transmitted we would be happy to hear from you. You can write to the
with this Form 8935-T. Internal Revenue Service, Tax Products Coordinating
Signature. The contact or other responsible person at the Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
commercial passenger airline carrier must sign and date NW, IR-6526, Washington, DC 20224. Do not send these
Form 8935-T. forms to this address. Instead, see Where to file earlier.
Cat. No. 52695Z Form 8935-T (6-2009)
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