United States Additional Estate Tax Return

Form 706-A

(To report dispositions or cessations of qualified use under

section 2032A of the Internal Revenue Code) (Rev. September 2004)

Department of the Treasury

Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see page 4 of the separate instructions.

General Information

1a Name of qualified heir 2 Heir’s social 

1b Address of qualified heir (number and street, including apartment number, P.O. Box, or rural route) 3 Commencemen

1c City, town or post office, state, and ZIP code

4 Decedent’s name reported on Form 706 5 Decedent’s social security number 6 Date of death

Tax Computation (First complete Schedules A and B—see instructions.)

Value at date of death (or alternate valuation date) of all specially valued property that passed from

decedent to qualified heir:

1

a Without section 2032A election 1a

b With section 2032A election 1b

c Balance (subtract line 1b from line 1a) 1c

2 Value at date of death (or alternate valuation date) of all specially valued property in decedent’s estate:

a Without section 2032A election 2a

b With section 2032A election 2b

c Balance (subtract line 2b from line 2a) 2c

3 Decedent’s estate tax:

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

b Reported on Form 706 with section 2032A election 3b

c Balance (subtract line 3b from line 3a) 3c

4 Divide line 1c by line 2c and enter the result as a percentage 4 

5 Total estate tax saved (multiply line 3c by percentage on line 4) 5

Value, without section 2032A election, at date of death (or alternate

valuation date) of specially valued property shown on Schedule A of this

Form 706-A

6

6

7 Divide line 6 by line 1a and enter the result as a percentage 7 

8 Multiply line 5 by percentage on line 7 8

9 Total estate tax recaptured on previous Form(s) 706-A (attach copies of 706-A) 9

10 Remaining estate tax savings (subtract line 9 from line 5) (do not enter less than zero) 10

11 Enter the lesser of line 8 or line 10 11

12 Enter the total of column D, Schedule A, page 2 12

13 Enter the total of column E, Schedule A, page 2 13

14

Balance (subtract line 13 from line 12) (but enter the line 12 amount in the case of a disposition of

standing timber on qualified woodland)

14

15 Enter the lesser of line 11 or line 14 15

16 16

17 17

18 18

19 19

If you completed Schedule B, complete lines 16–19. If you did not complete Schedule B, skip lines 16–18 and ente

line 15 on line 19.

Enter the total cost (or FMV) from Schedule B

Divide line 16 by line 12 and enter the result as a percentage (do not enter more than 100%) 

Multiply line 15 by percentage on line 17

Additional estate tax, subtract line 18 from line 15 (do not enter less than zero)

Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and c

preparer other than taxpayer is based on all information of which preparer has any knowledge.

Signature of taxpayer/qualified heir Da

Signature of preparer other than taxpayer/qualified heir Da

Address (and ZIP code)

Part I

Part II

Cat. No. 10141S Form 
Form 706-A (Rev. 9-2004) 

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

List property in chronological order of disposition or cessation

A B C D 

Amount received (or fair

market value if applicable)

(see instructions)

Date of disposition

(or date qualified

use ceased)

Description of specially valued property and schedule and item

number where reported on the decedent’s Form 706

Item

number

1

Totals:

Enter total of column D on line 12 of the Tax Computation, and total of

column E on line 13 of the Tax Computation.

Form 706, Schedule , Item

Description—

Form 
Form 706-A (Rev. 9-2004) 

Schedule B.—Involuntary Conversions or Exchanges Check if for: Involuntary conversio

Qualified replacement (or exchange) property

B

Description of qualified replacement (or exchange) property

A

Item

Total cost (or FMV) (enter here and on line 16 of the Tax Computation)

1

Form 
Form 706-A (Rev. 9-2004) 

Schedule C.—Dispositions to Family Members of the Qualified Heir

Each transferee must enter into an agreement to be personally liable for any additional taxes imposed by sectio

the agreement must be attached to this Form 706-A. (See instructions.)

Last name First name 

Transferee #1: Social security number Relationship to the qualified heir

Description of property transferred

B

Description of specially valued property and schedule and item

number where reported on the decedent’s Form 706

A

Item

number

1

Last name First name 

Transferee #2: Social security number Relationship to the qualified heir

Description of property transferred

B

Description of specially valued property and schedule and item

number where reported on the decedent’s Form 706

A

Item

number

1

If there are more than two transferees, attach additional sheets using the same format.

Form 706, Schedule , Item

Description—

Form 706, Schedule , Item

Description—

Printed on recycled paper

Form