Certificate on Return of Deposition

• Legal Form Number: 16
• Section: Tax Court
• Court: U.S. Tax Court

UNITED STATES TAX COURT

WA SHI NG TON , DC 20 217

,

Petitioner(s)

v.

COMMISSIONER OF INTERNAL REVENUE,

Respondent

Docket No.

CERTIFICATE ON RETURN OF DEPOSITION

To the United States Tax Court:

I, , the person named in an order of this Court dated

, to take depositions in this case, hereby certify:

1. I proceeded, on , at the office of , at

Date

, at o’clock .m., under the said order

Ro om nu mber, street numbe r, stre et nam e, cit y and State

and in the presence of and ,

the counsel of the respective parties, to take the following depositions, viz:

, a witness produced

on behalf of the ;

Pet itioner or R espon dent

, a witness produced

on behalf of the ;

Pet itioner or R espon dent

, a witness produced

on behalf of the .

Pet itioner or R espon dent

2. Each witness was examined under oath at such times and places as conditions of adjournment required, and

the testimony of each witness (or each witness’s answers to the questions filed) was recorded or otherwise

reported and reduced to writing by me or under my direction.

3. After the said testimony of each witness was reduced to writing, the transcript of the testimony was read

and signed by the witness and was acknowledged by the witness to be the witness’s testimony, in all respects only

and correctly transcribed except as otherwise stated.

4. All exhibits introduced during the deposition are transmitted herewith, except to the following extent

agreed to by the parties or directed by the Court [state disposition of exhibits if not transmitted with the

deposition]:

5. This deposition taken on written questions pursuant to Rule 84 of the Rules of Practice and

was or was not

Procedure of the United States Tax Court. All such written questions are annexed to the deposition.

6. After the signing of the deposition, no alterations or changes were made therein.

7. I am not a relative or employee or counsel of any party, or a relative or employee or associate of such

counsel, nor am I financially interested in the action.

Sign ature of per son ta king d eposi tion

Offi cial ti tle

NO TE— This f orm, w hen p roper ly exec uted, shoul d be a ttache d to a nd bo und w ith the trans cript p reced ing th e first page

ther eof. I t shou ld the n be d eliver ed to the pa rty tak ing th e dep ositio n or su ch pa rty’s co unsel .

T.C . Form 16 ( 08/12 )

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