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Form 8283 (Rev. 12-2006)
Identifying number
Name(s) shown on your income tax return
Section B. Donated Property Over $5,000 (Except Certain Publicly Traded Securities)—List in this section only items (or groups of similar
items) for which you claimed a deduction of more than $5,000 per item or group (except contributions of certain publicly traded
securities reported in Section A). An appraisal is generally required for property listed in Section B (see instructions).
Information on Donated Property—To be completed by the taxpayer and/or the appraiser.
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Check the box that describes the type of property donated:
Collectibles**
Qualified Conservation Contribution
Other Real Estate
Securities
*Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and
other similar objects.
(c) Appraised fair
market value
(b) If tangible property was donated, give a brief summary of the overall
physical condition of the property at the time of the gift
(a) Description of donated property (if you need
more space, attach a separate statement)
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A
C
D
See instructions
(g) For bargain sales, enter
amount received
(f) Donor’s cost or
adjusted basis
(e) How acquired
by donor
(d) Date acquired
by donor (mo., yr.)
(i) Average trading price
of securities
(h) Amount claimed as a
deduction
A
B
C
D
Taxpayer (Donor) Statement—List each item included in Part I above that the appraisal identifies as having
a value of $500 or less. See instructions.
I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500
(per item). Enter identifying letter from Part I and describe the specific item. See instructions.
©
Date
©
Signature of taxpayer (donor)
©
Declaration of Appraiser
I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or
married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of my
appraisals during my tax year for other persons.
Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications as described in the
appraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based on a percentage of the appraised property
value. Furthermore, I understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to
the penalty under section 6701(a) (aiding and abetting the understatement of tax liability). In addition, I understand that a substantial or gross valuation misstatement
resulting from the appraisal of the value of the property that I know, or reasonably should know, would be used in connection with a return or claim for refund, may subject
me to the penalty under section 6695A. I affirm that I have not been barred from presenting evidence or testimony by the Office of Professional Responsibility.
Sign
Here
Signature
©
Date
©
Title
©
Identifying number
Business address (including room or suite no.)
City or town, state, and ZIP code
Donee Acknowledgment—To be completed by the charitable organization.
This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described
in Section B, Part I, above on the following date
©
Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part I (or any
portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that
form. This acknowledgment does not represent agreement with the claimed fair market value.
Name of charitable organization (donee)
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
Authorized signature
Title
Date
B
Equipment
Part III
Part IV
Part I
Part II
Note. In certain cases, you must attach a qualified appraisal of the property. See instructions.
Does the organization intend to use the property for an unrelated use?
©
Yes
No
Art* (contribution of less than $20,000)
Art* (contribution of $20,000 or more)
**Collectibles include coins, stamps, books, gems, jewelry, sports memorabilia, dolls, etc., but not art as defined above.
Intellectual Property
Other
Printed on Recycled Paper
Form 8283 (Rev. 12-2006)
Employer identification number
