8880 Credit for Qualified Retirement Savings Contributions

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
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I.R.S. SPECIFICATIONS
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FORM 8838, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
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1
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8838

(Rev. December 2006)

Action

Name(s) of consenting taxpayer(s)

Signature

O.K. to print
Revised proofs
requested

Consent To Extend the Time To Assess Tax Under
Section 367—Gain Recognition Agreement

Department of the Treasury
Internal Revenue Service

Date

OMB No. 1545-1395

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Attachment
Sequence No.

Attach to your income tax return.

145

Identifying number (see instructions)

Social security number of spouse (only if a joint
income tax return was filed)

Number, street, and room or suite no. (If a P.O. box, see instructions.)

City or town, state, and ZIP code

The taxpayer(s) listed above and the Commissioner of Internal Revenue, pursuant to the regulations under section 367, agree to
the following:
1 The amount of any Federal income tax due relating to the transfer described in item 5, below, on any income tax return
made by or for the above taxpayer(s) for the tax year ended
,
,
, may be
month
day
year
assessed at any time on or before

,

month

,

day

, (expiration date—see instructions).

year

2

This consent establishes an extended period for assessing tax. The expiration of the extended period may be suspended
or otherwise affected by the operation of law in the same manner as the original period. For example, if a notice of deficiency
in tax covered by this consent is issued, the period for assessing tax will not end prior to the end of the suspension period
provided for by section 6503(a), plus any time that remains in the assessment period, as extended, at the time the suspension
takes effect. Under no circumstances will this consent reduce the period of time otherwise provided by law for making an
assessment.

3
4

The consenting taxpayer(s) may file a claim for credit or refund for the tax assessed by reason of this consent within 6
months after the period ends for assessing tax established by this consent.
The amount of any deficiency assessment covered by this consent will be limited to the amount of any Federal income tax
due relating to the recognition of gain on the transfer described in item 5, including any penalties, additions to tax, and
interest attributable thereto and consequential changes to other items based on that adjustment.

5

Complete the following information:

a Date of transfer
b Description of the property transferred

c Name of transferee and identifying number, if any

Under penalties of perjury, I declare that I have examined this consent, including accompanying statements and schedules, and to the best of my knowledge and belief,
it is true, correct, and complete. A signed consent, properly completed in accordance with this form and its instructions, is deemed to have been executed by the
Commissioner of Internal Revenue.

©

Signature of consenting taxpayer (see instructions)

©

Date

©

Signature of spouse (complete only if a joint return is filed)

©

Date

©

Taxpayer’s representative sign here

©

Date

©

Corporate officer(s) sign here

©

Date

For Paperwork Reduction Act Notice, see the instructions.

Cat. No. 20471F

Form

8838

(Rev. 12-2006)