Form Determination Under Section 860(e)(4) by a
(July 2009)8927 OMB No. 1545-2130
Qualified Investment Entity
Department of the Treasury
Internal Revenue Service See instructions.
For calendar year 20 or tax period beginning , 20 , and ending , 20 .
Name of regulated investment company (RIC) or real estate investment trust (REIT) Employer identification number (EIN)
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
Service Center where the tax return for the year entered above was or will be filed
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete.
Sign
Here
Signature of officer Title Date
General Instructions Date of Determination You are not required to provide
the information requested on a form
Section references are to the Generally, the date Form 8927 is that is subject to the Paperwork
Internal Revenue Code unless mailed is the date of determination Reduction Act unless the form
otherwise noted. under section 860(e)(4). See Section displays a valid OMB control
4 of Rev. Proc. 2009-28 for details. number. Books or records relating to
Purpose of Form a form or its instructions must be
File Form 8927 to make a Specific Instructions retained as long as their contents
determination under section Name and Address may become material in the
860(e)(4). When properly completed administration of any Internal
and filed with the Internal Revenue Enter the name and address of the Revenue law. Generally, tax returns
Service, Form 8927 will be treated RIC or REIT that is filing Form 8927. and return information are
as a statement by the taxpayer If the post office does not deliver confidential, as required by
attached to its amendment or mail to the street address and the section 6103.
supplement to a return of tax for the corporation has a P.O. box, show The time needed to complete and
relevant tax year for purposes of the number instead.
file this form will vary depending on
section 860(e)(4). For more If the RIC or REIT receives its mail individual circumstances. The
information, see Rev. Proc. 2009-28, in care of a third party (such as an estimated average time is:
2009-20 I.R.B. 1011, available at accountant or an attorney), enter on Recordkeeping 2 hr., 9 min.
www.irs.gov/irb/2009-20_IRB/ the street address line “C/O”
ar11.html.
followed by the third party’s name Learning about the law
Who Must File and street address or P.O. box. or the form 18 min.
A RIC or REIT that seeks to make a Preparing, copying,
self-determination under section Paperwork Reduction Act assembling, and sending
the form to the IRS 20 min.
860(e)(4) must file Form 8927 with Notice
the Internal Revenue Service. If you have comments concerning
We ask for the information on this
the accuracy of these time estimates
Where To File form to carry out the Internal
or suggestions for making this form
Revenue laws of the United States.
File Form 8927 with the Internal simpler, we would be happy to hear
You are required to give us the
Revenue Service, P.O. Box 9941, from you. You can write to the
information. We need it to ensure
Mail Stop 4912, Ogden, UT 84409. Internal Revenue Service; Tax
that you are complying with these
Products Coordinating Committee;
When To File laws and to allow us to figure and
SE:W:CAR:MP:T:T:SP; 1111
collect the right amount of tax.
Constitution Ave., N.W.; IR-6526;
File Form 8927 when the RIC or
REIT seeks to make a Washington, DC 20224. Do not send
self-determination under Form 8927 to this office. Instead,
section 860(e)(4). see “Where To File.”
Cat. No. 37740X Form 8927 (7-2009)