Form 8876 Excise Tax on Structured Settlement Factoring Transactions

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TREASURY/IRS AND OMB USE ONLY DRAFT

8876

Form
(Rev. December 2025)
Department of the Treasury
Internal Revenue Service

Excise Tax on Structured
Settlement Factoring Transactions

OMB No. 1545-1826

Go to www.irs.gov/form8876 for instructions and the latest information.

Date of receipt of structured settlement payment rights .

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Identifying number

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

Country

ZIP or foreign postal code

1

Total undiscounted amount of structured settlement payments being acquired .

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1

2

Total amount paid for the above structured settlement payment rights .

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2

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Factoring discount. Subtract line 2 from line 1 .

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3

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Tax. Multiply line 3 by 40% (0.40) .

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Less: Tax paid with Form 7004, if any

6

Tax due. If line 4 is equal to or greater than line 5, subtract line 5 from line 4. For details on how
to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . . . . . .

6

Overpayment. If line 5 is greater than line 4, subtract line 4 from line 5 and complete lines 7b,
7c, and 7d . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7a

7a

b Routing number

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5

c Type:

Checking

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

City or town

Savings

d Account number

Sign
Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
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.

Signature

Paid
Preparer
Use Only

Preparer’s name

Date
Preparer’s signature

Title (if any)
Date

Firm’s name

PTIN

Firm’s EIN

Firm’s address

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Check
if
self-employed

Phone no.
Cat. No. 33529K

Form 8876 (Rev. 12-2025) Created 5/13/25