Form   8996                                   Qualified Opportunity Fund                                              OMB No. 1545-0123 

(Rev. December 2021)              ▶ Go to www.irs.gov/Form8996 for instructions and the latest information.           Attachment        
Department of the Treasury  
Internal Revenue Service                      ▶ Attach to your tax return. See instructions.                          Sequence No. 996
Name                                                                                                            Employer identification number 

Part I   General Information and Certification
1      Type of taxpayer:     Corporation               Partnership
2      Is the taxpayer organized for the purpose of investing in qualified opportunity zone (QOZ) property (other than another qualified 
       opportunity fund (QOF))?   
         No. STOP.  Do not file this form with your tax return.
         Yes.  Go to line 3.
3      Is this the first period the taxpayer is a QOF?
         Yes.  By  checking  this  box,  you  certify  that  by  the  end  of  the  taxpayer’s  first  QOF  year,  the  taxpayer’s  organizing 
         documents  include  a  statement  of  the  entity’s  purpose  of  investing  in  QOZ  property  and  a  description  of  the  trade  or 
         business(es) that the QOF is engaged in either directly or through a QOZ business. See instructions.
         No.  
4      If you checked “Yes” on line 3, provide the first month in which the fund chose to be a QOF . .      . . . . ▶
5      Did any investor dispose of, in part or in whole, their equity interest in the fund?
         Yes. Attach a statement with each investor’s name, the date of disposal, and the interest that they transferred during the
         QOF’s tax year.
         No.  
6        Do not check this box. Reserved for future use.

Part II  Investment Standard Calculation
7      Enter the amount from Part VI, line 2, for total QOZ property held by the taxpayer on the last day of
       the first 6-month period of the taxpayer’s tax year. See instructions if Part I, line 3, is “Yes”  . . . .   7
8      Total assets held by the taxpayer on the last day of the first 6-month period of the taxpayer’s tax year. 
       See instructions if Part I, line 3, is “Yes”  . . . . .    . . .    . . .   . .     . . . .   .      . . .   8
9      Divide line 7 by line 8  . . . .   . .  .       . . . .    . . .    . . .   . .     . . . .   .      . . .   9
10     Enter the amount from Part VI, line 3, for total QOZ property held by the taxpayer on the last day of the 
       taxpayer’s tax year . .    . . .   . .  .       . . . .    . . .    . . .   . .     . . . .   .      . . .   10
11     Total assets held by the taxpayer on the last day of the taxpayer’s tax year  .     . . . .   .      . . .   11
12     Divide line 10 by line 11  . . .   . .  .       . . . .    . . .    . . .   . .     . . . .   .      . . .   12
Part III Qualified Opportunity Fund Average and Penalty
13     Add lines 9 and 12  . .    . . .   . .  .       . . . .    . . .    . . .   . .     . . . .   .      . . .   13
14     Divide line 13 by 2.0. See instructions if Part I, line 3, is “Yes” . . .   . .     . . . .   .      . . .   14
15     Is line 14 equal to or more than 0.90? 
         Yes. Enter -0- on this line and file this form with your tax return.
         No. The fund has failed to maintain the investment standard. Complete Part IV to figure the penalty. 
         Enter the penalty from line 8 of Part IV on this line. See instructions . . .     . . . .   .      . . .   15
For Paperwork Reduction Act Notice, see your tax return instructions.                Cat. No. 37820G                Form 8996 (Rev. 12-2021)

Form 8996 (Rev. 12-2021)                                                                                                                                                                 Page 2
Part IV Line 15 Penalty
If you checked “No” in Part III, line 15, complete Part IV to figure the penalty. Enter the number from line 8 below on Part III, line 15. See instructions if Part I, line 3, is “Yes.” 
                                                    (a)     (b)                                                (c)                (d)             (e) 
                                                    Month 1 Month 2                                          Month 3            Month 4           Month 5
1 Total assets on the last day of the month  .
2 Multiply line 1 by 0.90 .    . . . .   . . .
3 Total  QOZ  property  on  the  last  day  of  the 
  month  . .   .         . . . . . . .   . . .
4 Subtract line 3 from line 2. If less than zero, 
  enter -0-  . .         . . . . . . .   . . .
5 Underpayment rate          . . . . .   . . .
6 Multiply line 4 by line 5    . . . .   . . .
7 Divide  line  6  by  12.0.  Round  up  to  two 
  decimal places. See instructions if Part I, line 
  3, is “Yes”  .         . . . . . . .   . . .
           (f)                       (g)            (h)     (i)                                                (j)                (k)             (l) 
        Month 6                    Month 7          Month 8 Month 9                                          Month 10           Month 11          Month 12
1
2
3
4
5
6
7

8 Penalty. Add columns (a) through (l) of line 7. Enter the total here and on Part III, line 15  . . . . . . . .   .  . . . . . . .   .  . . $
                                                                                                                                              Form 8996 (Rev. 12-2021)

Form 8996 (Rev. 12-2021)                                                                                                                                                                                         Page 3
Part V  QOZ Business Property—Directly Owned or Leased by Taxpayer
Enter every QOZ where QOZ business property directly owned or leased by the     QOZ business property held directly on last day of the first 6-month          QOZ business property held directly on last day of the tax year
                         taxpayer is located                                        period of the tax year
                         (a)                                                    (b)                                          (c)                              (d)                                         (e) 
                         QOZ No.                                                Owned Property Value                   Leased Property Value                  Owned Property Value                  Leased Property Value

1 If  the  taxpayer  directly  owned/leased  QOZ  business 
  property  used  in  one  or  more  QOZs,  see  instructions 
  and enter the total QOZ business property value from 
  the separate statement  .        . .       . . . . . .         .
Part VI QOZ Stock or Partnership Interests
                                                                                                                                                              Value of QOZ stock or partnership 
For every QOZ business in which the taxpayer holds stock or a partnership       Value of QOZ stock or partnership      Tangible property held by QOZ          interest held on last day of the      Tangible property held by QOZ 
interest, enter every QOZ in which the tangible property of the QOZ business is interest held on last day of the first business on last day of the first      tax year apportioned to               business on last day of the tax year
        located and the EIN of that QOZ business                                6-month period of the tax year         6-month period of the tax year         each QOZ
                                                                                apportioned to each QOZ
        (a)                                      (b)                            (c)                                    (d)       (e)                          (f)                                   (g)       (h) 
        QOZ No.                              EIN of QOZ Business                Investment Value                       Owned Property  Leased Property        Investment Value                      Owned Property  Leased Property 
(indicate non-QOZs by 99999999999)                                                                                     Value     Value                                                              Value     Value

1 If  additional  lines  are  needed,  see  instructions  and 
  enter  total  QOZ  business  value  held  by  the  taxpayer 
  from Part VII, line 2, columns (c) and (f)  .    . . .         .
2 6-month test QOZ property. Add Part V, columns (b) and (c), and Part VI, column (c). Enter the total here and on Part II, line 7  .                            .    . .          .
3 Year-end test QOZ property. Add Part V, columns (d) and (e), and Part VI, column (f). Enter the total here and on Part II, line 10  .                          .    . .          .
4 Type of accounting method used to value the property listed on this form.
        Applicable financial statement valuation method.
        Alternative valuation method.  
                                                                                                                                                                                                    Form 8996 (Rev. 12-2021)

Form 8996 (Rev. 12-2021)                                                                                                                                                                                      Page 4
Part VII QOZ Stock or Partnership Interests (continued)
                                                                                                                                                              Value of QOZ stock or partnership 
For every QOZ business in which the taxpayer holds stock or a partnership       Value of QOZ stock or partnership      Tangible property held by QOZ          interest held on last day of the      Tangible property held by QOZ 
interest, enter every QOZ in which the tangible property of the QOZ business is interest held on last day of the first business on last day of the first      tax year apportioned to               business on last day of the tax year
         located and the EIN of that QOZ business                               6-month period of the tax year         6-month period of the tax year         each QOZ
                                                                                apportioned to each QOZ
         (a)                       (b)                                          (c)                                    (d)   (e)                              (f)                                   (g)       (h) 
         QOZ No.                   EIN of QOZ Business                          Investment Value                       Owned Property  Leased Property        Investment Value                      Owned Property  Leased Property 
(indicate non-QOZs by 99999999999)                                                                                     Value Value                                                                  Value     Value

1 If  taxpayer  invested  in  QOZ  business(es)  that  have 
  locations  in  more  than  the  QOZs  listed  in  Part  VI  and 
  above,  see  instructions  and  enter  total  QOZ  business 
  value held by the taxpayer from continuation sheet  . .
2 Total  columns  (c)  and  (f).  Enter  the  total  here  and  on 
  Part VI, line 1, columns (c) and (f), respectively .  .
                                                                                                                                                                                                    Form 8996 (Rev. 12-2021)