Form 8874-A
(Rev. December 2011)
Department of the Treasury
Internal Revenue Service
Notice of Qualified Equity Investment for
New Markets Credit
OMB No. 1545-2065
1
Name of qualified community development entity (CDE) 2 EIN of qualified CDE
3 If applicable, name of parent taxpayer with whom CDE files
a consolidated tax return
4 If applicable, EIN of parent taxpayer with whom CDE files
a consolidated tax return
5 Name of taxpayer making qualified equity investment 6 TIN of taxpayer making qualified equity investment
7 Date of qualified equity investment (mm/dd/yyyy) 8 Amount of qualified equity investment
9 Total allowable credit
10a Allowable credit: Year 1
b Allowable credit: Year 2
c Allowable credit: Year 3
d Allowable credit: Year 4
e Allowable credit: Year 5
f Allowable credit: Year 6
g
Allowable credit: Year 7
Please
Sign
Here
Under penalties of perjury, I declare that the qualified equity investment identified above was received by the CDE identified above.
Signature of authorized official of CDE
Date
Type or print name
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 49311G
Form 8874-A (Rev. 12-2011)
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signature
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Form 8874-A (Rev. 12-2011)
Page 2
General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.
Purpose of Form
CDEs must provide notice to any taxpayer who acquires
a qualified equity investment in the CDE at its original
issue that the equity investment is a qualified equity
investment entitling the taxpayer to claim the new
markets credit. This form is used to make the notification
as required under Regulations section 1.45D-1(g)(2)(i)(A).
Where To File
Department of the Treasury
Internal Revenue Service Center
Philadelphia, PA 19255-0549
When To File
The original signed form must be provided by the CDE to
the taxpayer no later than 60 days after the date the
taxpayer makes the investment in the CDE. Send a copy
of the form to the IRS at the address listed above. Keep a
copy for your records.
A separate form must be provided for each qualified
equity investment.
Additional Information
For more details, see Form 8874, New Markets Credit,
section 45D, Regulations section 1.45D-1, and
www.cdfifund.gov.
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
average time is:
Recordkeeping . . . . . . . . . . 4 hr., 32 min.
Learning about the
law or the form . . . . . . . . . . . . 24 min.
Preparing and sending
the form to the IRS . . . . . . . . . . 28 min.
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
email us at: taxforms@irs.gov. Enter “Form 8874-A
Comment” on the subject line. Or write to: Internal
Revenue Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send the form to
this address. Instead, see Where To File above.
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