Form 8819
(Rev. September 2017)
Department of the Treasury
Internal Revenue Service
Dollar Election Under Section 985
File Form 8819 separately from your income tax return. See instructions.
Go to www.irs.gov/Form8819 for the latest information.
OMB No. 1545-0123
Name of corporation making election
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
Employer identification number
Tax year for which dollar election is
effective
1
Check the applicable box to indicate who is making the dollar election under
Regulations section 1.985-1(b)(2)(ii)(B)(2):
a
A noncontrolled section 902 corporation to elect the U.S. dollar as its (or its QBU branch’s) functional currency.
b
The majority domestic corporate shareholders of a noncontrolled section 902 corporation to elect the U.S. dollar as the
corporation’s (or the corporation’s QBU branch’s) functional currency.
2a
Name of noncontrolled section 902 corporation (do not complete if same as filer above)
b Country of organization or creation
c
Country where the principal place of business of the noncontrolled section 902 corporation is located and country of each of
its QBU branches. Attach additional sheets if necessary.
3 Enter the information requested below (see instructions). Attach additional sheets if necessary.
(a) Name of shareholder
(b) Address (street number, P.O.
box, city or town, state, and ZIP code)
(c) Identifying number
(d) Percent of stock
owned in each class
Common
Preferred 1 Preferred 2
4
Enter the names, addresses, and identifying numbers of all persons that are related to the noncontrolled section 902
corporation who are eligible QBUs (within the meaning of Regulations section 1.985-2(b)(1)) or that have a branch that is an
eligible QBU. Attach additional sheets if necessary.
Name Address
Identifying number
5
Enter the name, address, and identifying number of every domestic corporate shareholder notified of the dollar election as
required by Regulations section 1.985-2(c)(3)(i). Attach additional sheets if necessary.
Name Address
Identifying number
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.
Signature Title (if any) Date (MM/DD/YYYY)
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 10850K
Form 8819 (Rev. 9-2017)
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Form 8819 (Rev. 9-2017)
Page 2
Future Developments
For the latest information about developments related to
Form 8819 and its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/Form8819.
General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.
Purpose of Form
Form 8819 is filed by or on behalf of a noncontrolled
section 902 corporation (defined in section 904(d)(2)(E))
operating in a hyperinflationary environment that elects
the U.S. dollar as its (or its qualified business unit (QBU)
branch’s) functional currency.
Who Must File
• If an election is made by a noncontrolled section 902
corporation, Form 8819 must be filed by an authorized
officer or director of the corporation.
• If the election is made on behalf of a noncontrolled
section 902 corporation or branch of a noncontrolled
foreign corporation, Form 8819 must be filed by each of
the majority domestic corporate shareholders (as defined
in Regulations section 1.985-2(c)(3)).
Signature. If there is not enough space for all required
filers to sign Form 8819, attach a sheet showing each
additional signature, that person’s title, if any, and the
date signed. The attachment must be signed under
penalties of perjury.
When and Where To File
File Form 8819 within 180 days after the end of the tax
year for which the dollar election is made. Send it to the
following address.
Internal Revenue Service
P.O. Box 409101
Ogden, UT 84409
Specific Instructions
Address. Include the suite, room, or other unit number
after the street address. If the post office does not deliver
mail to the street address and the filer has a P.O. box,
show the box number instead of the street address.
Line 3. If the box on line 1a is checked, enter the name,
address, identifying number, and percentage of stock
owned (as defined in section 902(b)) in each class of
stock for each domestic corporate shareholder.
If the box on line 1b is checked, enter the name,
address, identifying number, and the percentage of stock
owned (within the meaning of section 958(a)) in each
class of stock for each domestic corporate shareholder
(as described in section 902(a)) making the election.
Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. You are required to give us the
information. We need it to ensure that you are complying
with these laws and to allow us to figure and collect the
right amount of tax.
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 OMB
control number. Books or records relating to a form or its
instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
burden for business taxpayers filing this form is approved
under OMB control number 1545-0123.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this form
simpler, we would be happy to hear from you. You can
send us comments from www.irs.gov/FormComment. Or
you can write to the Internal Revenue Service, Tax Forms
and Publications, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Don’t send the form to this
office. Instead, see When and Where To File, earlier.
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