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                                      Claim for Deficiency Dividends Deductions by a 
Form  976                           Personal Holding Company, Regulated Investment                                                              OMB No. 1545-0123 
(Rev. November 2022) 
Department of the Treasury                Company, or Real Estate Investment Trust
Internal Revenue Service                      (Under Section 547 or 860 of the Internal Revenue Code)
Name of entity                                                                                                                 Employer identification number

Number, street, and room or suite no. (If a P.O. box, see instructions.)                                                       Type of entity filing the claim:
                                                                                                                                   Personal holding company
City or town, state, and ZIP code                                                                                                  Regulated investment company
                                                                                                                                   Real estate investment trust
1     Amount of tax deficiency .          . . . .  . .            .      .   . . .   . . .   . . . . . .    .    .             1 
2     Tax year of deficiency ends:              /                 /            .
3 a   Amount paid .          .    . . .   . . . .  . .            .      .   . . .   . . .   . . . . . .    .    .             3a 
b     Date paid                   /       /     .
4     Amount unpaid. Subtract line 3a from line 1                 .      .   . . .   . . .   . . . . . .    .    .             4 
5     How was the deficiency established?
a         Tax Court Decision—Attach a copy.
b         Court Judgment—Attach a copy. If established by a final judgment in a suit against the
          United States for refund:
          (1) Date the claim for refund was filed                          /       /       .
          (2) Date the suit was brought            /                       /       .
c         Closing agreement under section 7121.
d         If  a  personal  holding  company,  agreement  under  section  547(c)(3)—Attach  a  copy  of  a 
          properly executed Form 2198.
e         If a regulated investment company or real estate investment trust, agreement under section
          860(e)(3)—Attach a copy of the agreement.
f         If  a  regulated  investment  company  or  real  estate  investment  trust,  a  statement  under 
          section 860(e)(4)—Attach a copy of the Form 8927 filed with the IRS (see instructions).
6     Determination date (see instructions)                       /            /        .
7     Date the deficiency dividend was distributed                       /       /       . (Attach a certified copy of the
      resolution of the board of directors or other authority authorizing the payment of the deficiency dividend.)
8     Deficiency dividend was distributed as follows:
a     Cash  .        .   .   .    . . .   . . . .  . .            .      .   . . .   . . .   . . . . . .    .    .             8a 
b     Other property (attach description): 
      (1) Fair market value  .        .   . . . .  . .            .      .   . . .   . . .   . . . . . .    .    .             8b(1)
      (2) Adjusted basis  .         . .   . . . .  . .            .      .   . . .   . . .   . . . . . .    .    .             8b(2)
9 a   Amount claimed as a deduction for deficiency dividends  .                      . . .   . . . . . .    .    .             9a 
b     For a regulated investment company or real estate investment trust, enter the amount of line
      9a designated or reported as capital gain dividends  .                   . .   . . .   . . . . . .    .    .             9b
10    Only personal holding companies must complete line 10.
                                                                                         (b) Class of stock and number of      (c) Amount of deficiency dividend 
                         (a) Name and address of each shareholder                        shares of each class of stock held at paid to each shareholder on each 
                                                                                        date of payment of deficiency dividend      class of stock

               Under penalties of perjury, I declare that I have examined this claim, including accompanying schedules and statements, and to the best of my knowledge and 
               belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign  
Here
               Signature of officer                                                Date                Title
               Print/Type preparer’s name            Preparer’s signature                            Date                      Check         if PTIN
Paid                                                                                                                           self-employed
Preparer 
               Firm’s name                                                                                       Firm’s EIN
Use Only
               Firm’s address                                                                                    Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.                            Cat. No. 17061B                    Form 976 (Rev. 11-2022)



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Form 976 (Rev. 11-2022)                                                                                                                                    Page 2 
Instructions                                                                     Line 1. Enter the amount of the tax liability established by the determination 
                                                                                 without taking into account the deficiency dividend deduction claimed and 
Section references are to the Internal Revenue Code unless otherwise noted.      without regard to whether the tax liability is (or was) a deficiency as defined 
                                                                                 under section 6211(a)(1).
Future Developments                                                              Attach a detailed statement that discloses the computation of the tax 
For the latest information about developments related to Form 976 and its        deficiency amount reported on line 1. This statement should identify each 
instructions, such as legislation enacted after they were published, go to       amount and item that changes income, expenses, or credits as reported on 
www.irs.gov/Form976.                                                             the original or amended Form 1120-REIT, Form 1120-RIC, or Schedule PH 
                                                                                 (Form 1120), as applicable. For RICs and REITs, this should include the 
Purpose of form. File Form 976 for a personal holding company (PHC),             amount of the adjustment resulting from the determination, as required under 
regulated investment company (RIC), or real estate investment trust (REIT)       section 860(a), and as described in section 860(d)(1) or (d)(2), as applicable. 
that is claiming a deficiency dividend deduction under section 547 or 860. If    Also, provide an explanation for these changes. 
the claim is allowed, taxpayers will be relieved, in whole or in part, from the 
payment of certain taxes (or allowed a credit or refund of certain taxes). In    For RICs or REITs that are partners in a partnership subject to the 
addition, a RIC or REIT will owe interest determined with respect to the         centralized partnership audit regime set out in sections 6221 through 6241 
amount of the deficiency dividend deduction allowed. See sections 860(a),        (as amended by the Bipartisan Budget Act of 2015), this detailed statement 
860(c), 6601, and 6621. The IRS will notify the RIC or REIT of the amount of     (including the amount of any adjustment resulting from the determination) 
interest.                                                                        meets part of the documentation requirements for purposes of sections 
                                                                                 6225(c) and 6226 and the regulations thereunder with respect to adjustments 
When and where to file. File Form 976 within 120 days after the                  allocated to RICs or REITs.
determination date (defined below). A PHC must file Form 976 with the IRS 
office where the determination of PHC status was made. A RIC or REIT must        Line 2. Enter the ending date of the tax year for which the deficiency 
file Form 976 with the Internal Revenue Service Center where the income tax      dividend deduction is claimed. A separate Form 976 must be filed for each 
return for the tax year for which the determination applies was filed, unless    deficiency dividend deduction claimed.
the situations below apply.                                                      Line 3a. Enter the amount paid, if any, of the tax liability entered on line 1 
  If the determination is made by a RIC or REIT under section 860(e)(4), file    without taking into account the deficiency dividend deduction.
Form 976 with the Internal Revenue Service, P.O. Box 9941, Mail Stop 4912,       Line 5f. A RIC or REIT can file Form 8927 with the IRS to make a self-
Ogden, UT 84409. This is the same address for filing Form 8927,                  determination. If a statement is used instead of Form 8927, attach a copy of 
Determination Under Section 860(e)(4) by a Qualified Investment Entity.          the statement to Form 976.
  If the determination is from an agreement with the delegate (under section     Line 6. See Determination date  , earlier, for more information.
547(c)(3) or 860(e)(3)), any claim resulting from the deficiency dividend        Line 8b. If a stock distribution by a publicly traded RIC or REIT meets all the 
deduction may be filed with the delegate or corresponding IRS office.            requirements of section 3.02 of Rev. Proc. 2010-12, the RIC or REIT that 
Deficiency dividends. Deficiency dividends must be distributed no later than     made the distribution must enter the fair market value of the stock distributed 
90 days after the determination date (defined below) and prior to filing         on line 8b(1) and is not required to complete line 8b(2). See Rev. Proc. 
Form 976.                                                                        2010-12 for more information.
  The deficiency dividend must be of such a nature as would have permitted       Signature. The return must be signed and dated by the president, vice 
its inclusion in the computation of the deduction for dividends paid under       president, treasurer, assistant treasurer, or chief accounting officer, or any 
section 561 for the tax year for which the tax liability exists, if it had been  other officer (such as tax officer) authorized to sign. A receiver, trustee, or 
distributed during that year.                                                    assignee must sign and date any return filed on behalf of the company or        trust.
Determination date. If the determination was made by:                            If an officer completed Form 976, the Paid Preparer Use Only space under 
• A decision of the Tax Court, the determination date is the date the decision   “Signature of officer” should remain blank. If someone prepares Form 976 
becomes final under section 7481.                                                and does not charge the corporation, that person should not sign the return. 
                                                                                 Certain others who prepare Form 976 should not sign. For example, a 
• A judgment, decree, or order by a court, the determination date is the date    regular, full-time employee, such as a clerk, secretary, etc., should not sign.
the judgment, decree, or order becomes final.
                                                                                 Generally, anyone who is paid to prepare Form 976 must sign the return 
• A closing agreement made under section 7121, the determination date is         and fill in the other blanks in the “Paid Preparer Use Only” section of the 
the date the agreement is approved by the Commissioner.                          return.
• An agreement between the IRS and the taxpayer under section 547(c)(3)          The preparer required to sign the return must complete the required 
(Form 2198) (see below) or section 860(e)(3) and the signed copy of the          preparer information and:
agreement is sent to the taxpayer by registered mail, the determination date 
is the date of the registration. If the agreement is sent by certified mail, the • Sign it, by hand, in the space provided for the preparer’s signature 
determination date is the date of the postmark on the sender’s receipt. But if   (signature stamps or labels are not acceptable); and
the dividend is paid before the registration or postmark date, and on or after   • Give a copy of Form 976 to the taxpayer in addition to the copy filed with 
the date the agreement is signed by the delegate of the Commissioner, the        the IRS.
determination date is the date the agreement was signed.
• A RIC or REIT under section 860(e)(4) (Form 8927), in general, the             Paperwork Reduction Act Notice.We ask for the information on this form 
determination date is the date Form 8927 was mailed to the IRS. See Rev.         to carry out the Internal Revenue laws of the United States. We need it to 
Proc. 2009-28 for more information. A RIC or REIT should retain written          ensure that you are complying with these laws and to allow us to figure and 
evidence with its records to establish the date Form 8927 was mailed.            collect the right amount of tax.
  Enter this date on line 6.                                                     You are not required to provide the information requested on a form that is 
                                                                                 subject to the Paperwork Reduction Act unless the form displays a valid 
Form 2198. Form 2198, Determination of Liability for Personal Holding            OMB control number. Books or records relating to a form or its instructions 
Company Tax Section 547(c)(3) of the Internal Revenue Code, is used as the       must be retained as long as their contents may become material in the 
agreement required by section 547(c)(3). The form is jointly signed by a         administration of any Internal Revenue law. Generally, tax return and return 
delegate of the Commissioner of Internal Revenue and a qualified officer of      information are confidential, as required by section 6103.
the PHC to establish the PHC’s tax liability.
                                                                                 The time needed to complete and file this form will vary depending on 
Claim for credit or refund. If the allowance of the deficiency dividend          individual circumstances. The estimated average time is:
deduction results in an overpayment of tax, the taxpayer must file an 
amended income tax return in addition to Form 976 to obtain a credit or          Recordkeeping        .   . .     .  . .     .   .  .    . .  .     5 hr., 44 min.
refund of the overpayment.                                                       Learning about the law or the form    .     .   .  .    . .  .   .   .    53 min.
Corporate acquisitions. When the assets of one corporation are acquired          Preparing, copying, assembling, and 
by another corporation in a distribution or transfer described in section        sending the form to the IRS      .  . .     .   .  .    . .  .   . 1 hr.,  2 min.
381(a), see sections 381(c)(17) and 381(c)(23) for special rules for claiming a  If you have comments concerning the accuracy of these time estimates or 
deficiency dividend deduction.                                                   suggestions for making this form simpler, we would be happy to hear from 
Address. Include the suite, room, or other unit number after the street          you. You can send us comments from www.irs.gov/FormComments . Or you 
address. If the Post Office does not deliver mail to the street address and the  can also write to the Internal Revenue Service, Tax Forms and Publications 
taxpayer has a P.O. box, show the box number instead of the street address.      Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do 
                                                                                 not send this form to this office. Instead, see When and where to file above.






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