United States Gift (and Generation-Skipping Transfer) Tax Return Form 709 (For gifts made during calendar year 2004)

OMB No. 1545-0020

Department of the Treasury

Internal Revenue Service  See separate instructions.

1 2 Donor’s first name and middle initial Donor’s last name 3 Donor’s social security number

4 Address (number, street, and apartment number) 5 Legal residence (domicile) (county and state)

6 City, state, and ZIP code 7 Citizenship

Yes No 8 If the donor died during the year, check here  and enter date of death , .

9 If you received an extension of time to file this Form 709, check here  and attach the Form 4868, 2688, 2350, or 8892

10 Enter the total number of donees listed on Schedule A—count each person only once. 

11a Have you (the donor) previously filed a Form 709 (or 709-A) for any other year? If "No," skip line 11b

12 Gifts by husband or wife to third parties.—Do you consent to have the gifts (including generation-skipping transfers) made

by you and by your spouse to third parties during the calendar year considered as made one-half by each of you? (See

instructions.) (If the answer is “Yes,” the following information must be furnished and your spouse must sign the consent

shown below. If the answer is “No,” skip lines 13–18 and go to Schedule A.)

13 Name of consenting spouse 14 SSN

Part 1—General Information

15 Were you married to one another during the entire calendar year? (see instructions)

16 If 15 is “No,” check whether

17 Will a gift tax return for this year be filed by your spouse? (If “Yes,” mail both returns in the same envelope.)

Consent of Spouse—I consent to have the gifts (and generation-skipping transfers) made by me and by my spouse to third parties during the calendar year

considered as made one-half by each of us. We are both aware of the joint and several liability for tax created by the execution of this consent.

18

Consenting spouse’s signature  Date 

1 Enter the amount from Schedule A, Part 4, line 11 1

2 Enter the amount from Schedule B, line 3 2

3 Total taxable gifts (add lines 1 and 2) 3

4 Tax computed on amount on line 3 (see Table for Computing Tax in separate instructions) 4

5 Tax computed on amount on line 2 (see Table for Computing Tax in separate instructions) 5

6 Balance (subtract line 5 from line 4) 6

7 Maximum unified credit (nonresident aliens, see instructions) 7 345,800 00

8 Enter the unified credit against tax allowable for all prior periods (from Sch. B, line 1, col. C) 8

9 Balance (subtract line 8 from line 7) 9

10 Enter 20% (.20) of the amount allowed as a specific exemption for gifts made after September 8,

1976, and before January 1, 1977 (see instructions) 10

11 Balance (subtract line 10 from line 9) 11

12 Unified credit (enter the smaller of line 6 or line 11) 12

13 Credit for foreign gift taxes (see instructions) 13

14 Total credits (add lines 12 and 13) 14

15

Part 2—Tax Computation 15 Balance (subtract line 14 from line 6) (do not enter less than zero)

16 Generation-skipping transfer taxes (from Schedule C, Part 3, col. H, Total) 16

17 Total tax (add lines 15 and 16) 17

18 Gift and generation-skipping transfer taxes prepaid with extension of time to file 18

19 If line 18 is less than line 17, enter balance due (see instructions) 19

20 If line 18 is greater than line 17, enter amount to be refunded 20

Attach check or money order here.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 12 of the separate instructions for this form. Cat. No. 16783M Form 709 (2004)

11b If the answer to line 11a is "Yes," has your address changed since you last filed Form 709 (or 709-A)?

married divorced or widowed/deceased, and give date (see instructions) 

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

knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than donor) is based on all information of which preparer has

any knowledge. Sign

Here

Signature of donor Date

Preparer’s Date

signature Check if Paid self-employed 

Preparer’s

Use Only Firm’s name (or 

yours if self-employed), 

address, and ZIP code





 Phone no.  ( )

2004
SCHEDULE A

Form 709 (2004) Page 2

Computation of Taxable Gifts (Including transfers in trust) (see instructions)

Part 1—Gifts Subject Only to Gift Tax. Gifts less political organization, medical, and educational exclusions—see instructions

F

Value at

date of gift

E

Date

of gift

D

Donor’s adjusted

basis of gift

A

Item

number

1

Part 2—Direct skips— gifts that are direct skips and are subject to both gift tax and generation-skipping transfer tax. You must list the

gifts in chronological order.

F

Value at

date of gift

E

Date

of gift

D

Donor’s adjusted

basis of gift

A

Item

number

1

(If more space is needed, attach additional sheets of same size.)

B

B

● Donee’s name and address

● Relationship to donor (if any)

● Description of gift

● If the gift was of securities, give CUSIP no.

● If closely held entity, give EIN

Does the value of any item listed on Schedule A reflect any valuation discount? If “Yes,” see instructions Yes No

Gifts made by spouse—complete only if you are splitting gifts with your spouse and he/she also made gifts.

Total of Part 2 (add amounts from Part 2, column H) 

 Check here if you elect under section 529(c)(2)(B) to treat any transfers made this year to a qualified tuition program as made

ratably over a 5-year period beginning this year. See instructions. Attach explanation.

B

A

Form 709 (2004)

C

H

Net transfer

(subtract

col. G from

col. F)

G

For split

gifts, enter 1⁄2 of

column F

Total of Part 1 (add amounts from Part 1, column H) 

● Donee’s name and address

● Relationship to donor (if any)

● Description of gift

● If the gift was of securities, give CUSIP no.

● If closely held entity, give EIN

G

For split

gifts, enter 1⁄2 of

column F

C

2632(b)

election

out

Part 3—Indirect skips— gifts to trusts that are currently subject to gift tax and may later be subject to generation-skipping transfer tax.

You must list these gifts in chronological order.

F

Value at

date of gift

E

Date

of gift

D

Donor’s adjusted

basis of gift

A

Item

number

1

B

● Donee’s name and address

● Relationship to donor (if any)

● Description of gift

● If the gift was of securities, give CUSIP no.

● If closely held entity, give EIN

G

For split

gifts, enter 1⁄2 of

column F

C

2632(c)

election

H

Net transfer

(subtract

col. G from

col. F)

H

Net transfer

(subtract

col. G from

col. F)

Gifts made by spouse—complete only if you are splitting gifts with your spouse and he/she also made gifts.

Gifts made by spouse—complete only if you are splitting gifts with your spouse and he/she also made gifts.

Total of Part 3 (add amounts from Part 3, column H) SCHEDULE B

Form 709 (2004) Page 3

12 Terminable Interest (QTIP) Marital Deduction. (See instructions for line 4 of Schedule A.)

13 Election Out of QTIP Treatment of Annuities

 Check here if you elect under section 2523(f)(6) NOT to treat as qualified terminable interest property any joint and survivor annuities that re

reported on Schedule A and would otherwise be treated as qualified terminable interest property under section 2523(f). (See instructions.) Enter

the item numbers (from Schedule A) for the annuities for which you are making this election 

Gifts From Prior Periods

D

Amount of specific

exemption for prior

periods ending before

January 1, 1977

C

Amount of unified

credit against gift tax

for periods after

December 31, 1976

A

Calendar year or

calendar quarter

(see instructions)

E

Amount of

taxable gifts

B

Internal Revenue office

where prior return was filed

1 Totals for prior periods 1

Amount, if any, by which total specific exemption, line 1, column D, is more than $30,000 2 2

Total amount of taxable gifts for prior periods (add amount, column E, line 1, and amount, if any, on

line 2). (Enter here and on line 2 of the Tax Computation on page 1.)

3

3

(If more space is needed, attach additional sheets of same size.)

If a trust (or other property) meets the requirements of qualified terminable interest property under section 2523(f), and

a. The trust (or other property) is listed on Schedule A, and

b. The value of the trust (or other property) is entered in whole or in part as a deduction on line 4, Part 4 of Schedule A,

then the donor shall be deemed to have made an election to have such trust (or other property) treated as qualified terminable interest property

under section 2523(f).

If less than the entire value of the trust (or other property) that the donor has included in Parts 1 and 3 of Schedule A is entered as a

deduction on line 4, the donor shall be considered to have made an election only as to a fraction of the trust (or other property). The numerator

of this fraction is equal to the amount of the trust (or other property) deducted on line 6 of Part 4, Schedule A. The denominator is equal to the

total value of the trust (or other property) listed in Parts 1 and 3 of Schedule A.

If you answered “Yes” on line 11a of page 1, Part 1, see the instructions for completing Schedule B. If you answered “No,” skip to the Tax

Computation on page 1 (or Schedule C, if applicable).

If you make the QTIP election (see instructions for line 4 of Schedule A), the terminable interest property involved will be included in your

spouse’s gross estate upon his or her death (section 2044). If your spouse disposes (by gift or otherwise) of all or part of the qualifying life

income interest, he or she will be considered to have made a transfer of the entire property that is subject to the gift tax (see Transfer of Certain

Life Estates on page 4 of the instructions).

Form 709 (2004)

Part 4—Taxable Gift Reconciliation

1 Total value of gifts of donor (add totals from column H of Parts 1, 2, and 3) 1

3

4

5

Total annual exclusions for gifts listed on line 1 (see instructions) 2

6

Total included amount of gifts (subtract line 2 from line 1) 3

7

Deductions (see instructions)

Gifts of interests to spouse for which a marital deduction will be claimed, based

on items of Schedule A

8

4

Exclusions attributable to gifts on line 4 5

9

Marital deduction—subtract line 5 from line 4 6

10

Charitable deduction, based on items less exclusions 7

11

Total deductions—add lines 6 and 7 8

Subtract line 8 from line 3 9

Generation-skipping transfer taxes payable with this Form 709 (from Schedule C, Part 3, col. H, Total) 10

Taxable gifts (add lines 9 and 10). Enter here and on line 1 of the Tax Computation on page 1 11

2
Form 709 (2004) Page 4

Part 2—GST Exemption Reconciliation (Section 2631) and Section 2652(a)(3) Election

Check box  if you are making a section 2652(a)(3) (special QTIP) election (see instructions)

Enter the item numbers (from Schedule A) of the gifts for which you are making this election  

1 Maximum allowable exemption (see instructions) 1

2 Total exemption used for periods before filing this return 2

3 Exemption available for this return (subtract line 2 from line 1) 3

4 Exemption claimed on this return (from Part 3, col. C total, below) 4

6 Exemption allocated to transfers not shown on line 4 or 5, above. You must attach a Notice of Allocation.

(See instructions.) 6

7 Add lines 4, 5, and 6 7

8 Exemption available for future transfers (subtract line 7 from line 3) 8

Part 3—Tax Computation

H

Generation-Skipping

Transfer Tax

(multiply col. B by col. G)

G

Applicable Rate

(multiply col. E

by col. F)

F

Maximum Estate

Tax Rate

E

Inclusion Ratio

(subtract col. D

from 1.000)

D

Divide col. C

by col. B

B

Net transfer

(from Schedule C,

Part 1, col. D)

C

GST Exemption

Allocated

A

Item No.

(from Schedule

C, Part 1)

1 48% (.48)

2

3

4

5

6

Total exemption claimed. Enter

here and on line 4, Part 2,

above. May not exceed line 3,

Part 2, above

Total generation-skipping transfer tax. Enter here, on line 10 of

Schedule A, Part 4, and on line 16 of the Tax Computation on

page 1

(If more space is needed, attach additional sheets of same size.)

SCHEDULE C Computation of Generation-Skipping Transfer Tax

Note: Inter vivos direct skips that are completely excluded by the GST exemption must still be fully reported

(including value and exemptions claimed) on Schedule C.

Part 1—Generation-Skipping Transfers

D

Net Transfer (subtract

col. C from col. B)

B

Value (from Schedule A,

Part 2, col. H)

A

Item No.

(from Schedule A,

Part 2, col. A)

C

Nontaxable

portion of transfer

1

48% (.48)

48% (.48)

48% (.48)

48% (.48)

48% (.48)

48% (.48)

48% (.48)

48% (.48)

48% (.48)

Form 709 (2004)

Gifts made by spouse (for gift splitting only)

5 Automatic allocation of exemption to transfers reported on Schedule A, Part 3 5

48% (.48)

48% (.48)