rom 106-A United States Additional Estate Tax Return OMB No, 1545-0016

(Rev. November 1981) | (To report dispositions or cessations of qualified use made before January 1, 1982 under | FPires 9-30-84

Department of the Treasury
Internal Revenue Service section 2032A of Internal Revenue Code)

Name of qualified heir or heiress Heir's or heiress’ social security number

Address of qualified heir or heiress (number and street including apartment number or rural route)

City, town or post office, State, and ZIP code

Decedent's name reported on Form 706 Decedent's social security number Date of death

Tax Computation

Value at date of death of specially valued property which passed from decedent to qualified heir or heiress:
(a) Without section 2032A election. 2 2 ee ee ee ee ee ee LA)
(b) With section 2032A election. . . . - . 1 . Le
(c) Balance (subtract amount on line 1(b) from amount on line 1(2)) . er
2 Value at date of death of all specially valued property in decedent's estate:

»

*
IS

(a) Without section 2032A election. 2 2 6 6 6 ee ee ee ee

(b) With section 2032A election. ©. 2 ee ee ee 2 ee 120)

(c) Balance (subtract amount on line 2(b) from amount on line 2(@)) « ee ee ee ee ee LZ)
3 Decedent's estate tax: 7/

(a) Recomputed without section 2032A election (attach computation). . . . - 3(a)|

(b) Reported on Form 706 with section 2032Aelection. . . . 2. + « L3Cb) HLA

(c) Balance (subtract amount on line 3(b) from amount on line 3(a)). . - 2 ee ee ee eet [8D
4 Percentage obtained by dividing amount on line 1(c) by amount on line 2c). - » se ee ee ee
5 Multiply amount on line 3(c) by percentage on line4. . . . cee woe eee . |S
6 Additional estate tax imposed for previous dispositions or cessation of qualified use of portion of same

specially valued property. 2 2 ee 8 ee ee ee ee a
7 Balance (subtract amount on line 6 from amount online 5). 0. ee ee ee ee ee ee PZ
8 Enter the total of column (d), Schedule A, page2. 06. 6 ee ee ee ee FB
9 Enter the total of column (e), Schedule A, page2. . - - - ee ee ee ee —
10 Balance (subtract amount on line 9 from amount on line 8). . « « rrr 10 _|
11 Additional estate tax. Enter the lesser of the amount on line 7 or the amount online10. . . . . 11

[SMM Tax Phaseout (Complete Part II only if the disposition of specially valued property or the discontinuance of the qualified use
occurred more than 120 full months (10 years) after but less than 180 full months (15 years) after the decedent's death. After
180 full months (15 years) after decedent's death, no additional estate tax is due.)

12 Enter the number of full months after the decedent's death in excess of 120 months (10 years) when the
qualified heir or heiress disposed of the interest or discontinued the qualifieduse. . . - . . s+ «+ + =

13 Divide amount on line 12 by60. . . . a

14 Multiply amount on line 11 by amountonline 13. . . we ee oe

15 Subtract amount on line 14 from amount on line 11 (but not less than zero) | woe ee

EZMMl Involuntary Conversions (Complete Part Ill if you elect section 2032A(h) treatment and less than all of the involuntary
conversion proceeds are reinvested in qualified replacement property.)

Describe the replacement property >.

16 Cost of qualified replacement property. © 6 6 ee et ee ee ee [6

17 Amount realized from involuntary conversion. . . rr 17

18 Percentage obtained by dividing amount on line 16 bya amountonlinel17. 2 6. ee eee ee (2B %
19 Multiply amount on line 11 or line 15 (whichever is applicable) by percentage on line 18. . . . . . - j19_|

20 Subtract amount on line 19 from amount on line 11 or line 15 (whichever is applicable)... - . 20

Under penalties of perjury, | declare that | have examined this return, and to the best of my knowledge and belief, it is true, correct, and complete. Declara-

tion of roparer other than taxpayer is based on all information of which préparer has any knowledge.

Date

an taxpayer ~ Addi

Signature of preparer other t

For Paperwork Reduction Act Notice, see page 1 of the separate instructions. 343-499-1


Form 706-A (11-81)

Page 2

Schedule A.—Disposition of Specially Valued Property or Discontinuance of Qualified Use

Date of disposition (or date

Amount received (or fair

Item | Description of specially valued property and schedule and i Special use value.
F : qualified use ceased) (must | market value if applicable) ‘
number | item number where reported on the decedent's Form 706 | GUpified use ceased) (mu sey ua Hepple See instructions
@ (by © @ (}
1

Enter total of column (d) on line 8, page 1, and total of column (e) on line 9, page 1.

‘ty US. GOVERNMENT PRINTING OFFICE : 198\—O-343-499

343-499-1