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Form
     8935-T               Transmittal of Airline Payments Reports                                               OMB No. 1545-2140
(June 2009)
Department of the Treasury
Internal Revenue Service
1FILER’S name                                                           2 Employer identification number

                                                                        3aName of person to contact

 Street address (including room or suite number)                        3bTelephone number
                                                                          ()
 City, state, and ZIP code                                              3cEmail address

4Payment date(s)                                5Total 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.

SignatureTitleDatePrivacy Act and Paperwork Reduction Act Notice. We ask
Instructions
                                                                        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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