Sample Filled-Out Form 8300 printable pdf download

Sample Filled-Out Form 8300

The filled-out Form 8300 below is based on the following fictitious transaction and is for illustrative

purposes only. Additional or different parts of the form may need to be completed based on the facts of

each transaction. Refer to the Form 8300 instructions at

contact the University Tax Department at 432-5530 if you have any questions with respect to completing

this form.

Scenario:

On September 1, 2014, Jane Smith pays $11,000 in cash to the Office of Student

Financial Services. The payment is to be applied to the account of her son, Joseph Smith,

a Yale College student. The unpaid charges in Joseph’s account prior to the $11,000

payment include tuition, room, board, and fees totaling $18,000 for the fall 2014

semester.

Filling out Form 8300:

Part I

To complete Part I, the person who receives the payment must obtain the payer’s name, address,

taxpayer identification number (i.e. social security number or individual taxpayer identification number),

date of birth and occupation. In addition, the payer’s identity must be verified, for example, by a photo

driver’s license. This identity verification must be documented in Part I of the form.

Part II

Because, in this example, the payments are made by one person (Jane Smith) on another person’s behalf

(Joseph Smith), Part II must be completed. The information required by Part II may be in the

University’s records or may need to be provided by the payer.

If the payer is conducting a transaction on his/her own behalf, Part II need not be completed. In this

example, if Jane Smith were a student making a payment on her own student account (instead of her

son’s), Part II would not need to be completed.

Part III

The information required to complete Part III must be determined at the time of the transaction (e.g.,

form of “cash” payment, amount in $100 bills or higher) or obtained from the University’s records (e.g.,

total price and type of transaction).

Part IV

The address of the actual physical location where the cash was received (not a central University

address) is required to be disclosed. Form 8300 must be reviewed by the department supervisor or other

person who authorized the transaction; this person must then sign and date the form and indicate his/her

University title and phone number.

Note:

Page two of Form 8300 must be completed when there are multiple parties to the transaction. Part I on

page two must be completed if the reportable payment is received from more than one person. Part II on

page two must be completed if the reportable payment is made on behalf of more than one person.

Sample Filled-Out Form 8300