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Form 8283 (Rev. ".0-95~
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<br />EXHIBIT B2
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<br />paee 2
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<br />Na~(s) ~o~ on ~ur ~nco~ tax return
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<br /> Richard J. Deziel
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<br />Identifying number
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<br />470-14-3127
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<br />Section B--Appraisal Summary--List in this section only items (or groups of similar ir. ems) for which you claimed a
<br /> deduction of more than $5,000 per item cr group. Exception. Report contributions of certain publicly
<br /> traded securities only in Section A.
<br /> ir you donated art, you ma), have to attach the complete appraisal. See the Note in Part I below.
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<br />I~'T'~ll Information on Donated Property--To be completed by the taxpayer and/or appraiser.
<br /> 4 Check type of proper[),:
<br /> [] Art' (contribution of $20,000 or more) [] Real Estate [] Gems/Jewelry [] Stamp Collections
<br /> [] Art' (contribution of less than $20,000) [] Coin Collections [] Books [] Other
<br />'Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antique furniture, decorative arts, textiles, carpets, silver, rare
<br />manuscripts, historical memorabilia, and other similar objects.
<br />Note: If your total art contribution deduction was $20.000 or more. you must attach a complete copy of the signed appraisal. See instructions.
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<br />5. {a) Description of donated property (if you need
<br /> more space, attach a separate statement)
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<br />(b) If tangible property was donated, give a brief summary of the overall
<br /> physical condition at the time of the gift
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<br />(c) Appraised fair
<br /> market value
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<br />(d) Date acquired (®) How acquired
<br />b.y donor (mo., yr.) by donor
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<br />I (I) Donor's cost or (g) For bargain sales, enter
<br /> adjusted basis Iamount received
<br /> I
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<br /> See ~s~uctJon:;
<br />(h) Amount claimed as a J (i) Average trading price
<br /> deduction I of securities
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<br />Taxpayer (Donor) Statement--List each item included in Part I above that is separa[el), identified in the
<br /> appraisal as havinq~ a value of $500 or less. See instructions:
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<br />d~slare that the following item(s) i~cluded in Part ! above has to the best ot my knowledge and belief an appraised value of not more than $500
<br />t,~r~.r Eem). Enter iderltifyin9 letter from FaA I and describe t31e specific item..See instructions.
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<br />Signature of taxpayer (donor) ·
<br />ill :~l'illlI Declaration of
<br /> Appraiser
<br />
<br />Date ·
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<br />I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any
<br />of the foregoing persons, or married to any person who is related to any of the foregoing pemons. And, if regularly used by the donor, donee,, or
<br />party to the transaction, I performed the majodty of my appraisals dudng my tax year for other persons.
<br />Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications
<br />as described in the appraisal, 1 am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based
<br />on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulent overstatement of the property value as
<br />described in the qualified appraisal or this appraisal summary may subject me to the pe~atty under section 6701(a) (aiding and abetting the
<br />understatement of tax liability). I affirm that I have not been barred from presenting evidence or testimony by the Director of Practice.
<br />Sign ~ f'~ //'/ '~ ~/¢,.¢. ' ~
<br />Business adq~ess (including/room or/~ui.t~no.).~-~ /- ' '
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<br /> C~ty or~wn,,state, ar~ ZIP code
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<br /> l~ai~a Donee Acknowledgment--To be completed by_the charitable organization.
<br /> T~is charitable organization acknowledges [hat it is a qualified organization under section 170(c) and [hat it received the donated
<br />/ prope~y as described in Section B, Pa~ I, above on
<br /> (~te}
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<br /> Fu~hermore, ~is organization a~rms that in the event it sells, exchanges, or othe~ise disposes of the prope~y described in Section
<br /> B, Pa~ I (or any potion thereoO within 2 yearn aEer the date of receipt, it will file Form 8Z8~ Donee Information Return, with the
<br /> IRS and give the donor a copy of that form. This acknowledgment does not represent agreement with the claimed fair market value.
<br /> Na~ of c~,~ble organi~t~on {donee) Em~y~ ~fi~fi~ n~r
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<br /> A~ress (numar, ~reet, and room or suite no.) C~y or town, state, and ZIP code
<br /> A~or~ed sig~ture Title ~ Date
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