Form 8924 - Excise Tax On Certain Transfers Of Qualifying Geothermal Or Mineral Interests
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28924
Excise Tax on Certain Transfers of Qualifying
Form
Geothermal or Mineral Interests
OMB No. 1545-2099
(Rev. December 2013)
Department of the Treasury
Information about Form 8924 and its instructions is at
Internal Revenue Service
▶
Name of entity
Employer identification number
Number, street, and room or suite no. (If a P.O. box, see instructions)
City or town, state or province, country, and ZIP or foreign postal code
Tax Computation
1
Date of sale or other disposition (MM/DD/YYYY) .
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2
If the property was sold or exchanged, enter the sales price of the interest transferred. If the
2
property was leased, enter the income realized as a result of the transfer .
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3
Cost or other basis of interest transferred. Enter -0- if the property was leased .
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3
4
4
Gain or income realized. Subtract line 3 from line 2. If zero or less, enter -0- .
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5
Fair market value of the interest transferred as of the date shown on line 1
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5
6
Multiply line 5 by 20% (.20) .
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6
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7
Multiply line 4 by 35% (.35) .
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8
Tax. Add lines 6 and 7
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8
9
9
Tax paid with Form 7004 .
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10
Tax due. Enter the excess, if any, of line 8 over line 9
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Overpayment. Enter the excess, if any, of line 9 over line 8
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11
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
Sign
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here
Your signature
Date
Title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm's EIN
Firm's name
Use Only
▶
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Phone no.
Firm's address
▶
8924
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 12-2013)
Cat. No. 37736P
When To File
Section references are to the Internal Revenue
• A conservation sale in which the previous
Code.
transferor excluded 25% of the qualifying gain,
File Form 8924 by the 90th day following the
or
taxable transfer. If you need more time to file,
Future Developments
use Form 7004, Application for Automatic 6-
• A transfer in which the previous transferor was
For the latest information about developments
Month Extension of Time To File Certain
relieved of liability for the Form 8924 tax.
related to Form 8924 and its instructions, such
Business Income Tax, Information, and Other
as legislation enacted after they were published,
Relief from liability. An eligible entity is not
Returns, by the due date of Form 8924. Form
go to
required to file Form 8924 if:
7004 does not extend the time for payment of
tax.
General Instructions
• The transferee is an eligible entity which
provides the transferor with a qualifying letter of
Amended Return
Purpose of Form
intent at the time of the transfer,
To amend a previously filed Form 8924, file a
Use Form 8924 to report and pay the excise tax
• The transferee is not an eligible entity but
corrected Form 8924 and write “Amended” at
on certain transfers of qualifying geothermal or
establishes to the satisfaction of the Secretary of
the top of the form.
mineral interests.
the Treasury that the transfer of ownership or
possession will be consistent with section 170(h)
Who Must File
Where To File
(5) and provides the transferor with a qualifying
An eligible entity who subsequently transfers
Send Form 8924 to the following address.
letter of intent at the time of the transfer, or
ownership or possession (by sale, exchange, or
• Form 8924 tax has previously been paid as a
Department of the Treasury
lease) of a qualifying mineral or geothermal
result of a previous transfer of ownership or
Internal Revenue Service Center
interest must file Form 8924 for each transfer of
possession of the same interest.
Cincinnati, OH 45999
an interest acquired, directly or indirectly, in:
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