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Sample Form 3189 — Deficiency Dividend Deduction Case TransmittalThe sample form is an example of Form 3189, which is used to transmit Deficiency Dividend cases to the Campus. The sample form is an example of a completed form reflecting the name and address of the personal holding company, TIN and tax period ended 12/31/2002. The following section contains this sentence: The file contains a timely filed Form 976 claiming a deficiency dividend, which was paid during the taxable year ended (blank line). The blank line is completed with the phrase, December 31, 2004.In the Computation section, the three columns are completed as follows:Deficiency Before Deduction: $17,388.00Amount Attributable to Allowance of Deduction: $17,388.00Net Amount to be Assessed: $0.00The Remarks section contains the following statements:Interest should be computed from 03/15/2003 to 07/31/2004 on $17,388.Note: 03/15/2003 is the due date of the return.Note: 07/31/2004 is the date Form 976 was received by Technical Services.