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Donation Form 4

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Donation Form 4
Donation Form 4
Form 8283
(Rev. December 2012)
Department of the Treasury
Internal Revenue Service
Noncash Charitable Contributions
Attach to your tax return if you claimed a total deduction
of over $500 for all contributed property.
Information about Form 8283 and its separate instructions is at www.irs.gov/form8283.
OMB No. 1545-0908
Sequence No.
Name(s) shown on your income tax return Identifying number
Note. Figure the amount of your contribution deduction before completing this form. See your tax return instructions.
Section A. Donated Property of $5,000 or Less and Certain Publicly Traded Securities—List in this section only
items (or groups of similar items) for which you claimed a deduction of $5,000 or less. Also, list certain
publicly traded securities even if the deduction is more than $5,000 (see instructions).
Part I Information on Donated Property—If you need more space, attach a statement.
(a) Name and address of the
donee organization
(b) If donated property is a vehicle (see instructions),
check the box. Also enter the vehicle identification
number (unless Form 1098-C is attached)
(c) Description of donated property
(For a donated vehicle, enter the year, make, model,
condition, and mileage,
unless Form 1098-C is attached.)
Note. If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (e), (f), and (g).
(d) Date of the
(e) Date acquired
by donor (mo., yr.)
(f) How acquired
by donor
(g) Donor’s cost
or adjusted basis
(h) Fair market value
(see instructions)
(i) Method used to determine
the fair market value
Part II
Partial Interests and Restricted Use Property—Complete lines 2a through 2e if you gave less than an
entire interest in a property listed in Part I. Complete lines 3a through 3c if conditions were placed on a
contribution listed in Part I; also attach the required statement (see instructions).
Enter the letter from Part I that identifies the property for which you gave less than an entire interest
If Part II applies to more than one property, attach a separate statement.
b Total amount claimed as a deduction for the property listed in Part I: (1) For this tax year
(2) For any prior tax years
Name and address of each organization to which any such contribution was made in a prior year (complete only if different
from the donee organization above):
Name of charitable organization (donee)
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
For tangible property, enter the place where the property is located or kept
Name of any person, other than the donee organization, having actual possession of the property
Is there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donated
property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
Did you give to anyone (other than the donee organization or another organization participating with the donee
organization in cooperative fundraising) the right to the income from the donated property or to the possession of
the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to
designate the person having such income, possession, or right to acquire . . . . . . . . . . . . .
c Is there a restriction limiting the donated property for a particular use . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 62299J
Form 8283 (Rev. 12-2012)
Donation Form 4