Form 709 (Rev. 1-87)

Page 4

ea Uy Computation of Generation-Skipping Transfer Tax (continued)

Part 2.—Grandchild Exclusion Rect

‘onciliation

Name of Grandchild

A
Maximum
Allowable
Exclusion

B
Total of Exclus

Returns

Claimed on Previous

sions

c
Exclusion Available
for This Return
(subtract col. B from col. A)

D
Exclusion Claimed
on this Return

E
Exclusion Available
for Future Returns
(Subtract col. D from col. C)

$2,000,000

$2,000,000

$2,000,000

Total grandchild exclusions claimed on this return. Must equal total of column G, Part 1

Part 3.—GST Exemption Reconciliation (Code section 2631)

Oawne

instructions.) .
6 Addlines 4 and5

Maximum allowable exemption . .
Total exemption used for periods before filing this return :
Exemption available for this return (subtract line 2 from line 1) .

Exemption claimed on this return (from Part 4, col. C total, below) . cone
Exemption elected for transfers not shown on Part 4, below. You must attach a Notice of Allocation. (ee

7__Exemption available for future transfers (subtract line 6 from line 3) :

$1,000,000

Bw |r fe

ala

Part 4.—Tax Computation

B c
Gift No. Net transfer GST Exemption
(from Schedule | (from Schedule C, Allocated
C, Part 1) Part 1, col. H)

D
Divide col. C
by col. B

E
Inclusion Ratio
(subtract col. D
from 1.000)

F
Maximum Gift
Tax Rate
Gee instructions)

G
Applicable Rate
(multiply col. E

bycol. F)

H
Generation-Skipping
Transfer Tax
(multiply col. B by col. G)

Total exemption claimed. Enter
here and on line 4, Part 3,
above. May not exceed line 3,
Part 3, above

Total generation-skipping transfer tax. Enter here, on line 14
of Schedule A, Part 3, and on line 16 of the Tax x Computation

onpagel .

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Form 709 United States Gift (and Generation-Skipping Transfer) Tax Return

(Rev. January 1987) (Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1981, and before January 1, 1989) | OMBNo. 1545-0020

Department of the Treasury Calendar year 19 _____ Expires 12-31-89
Internal Revenue Service > For Privacy Act Notice, see the Instructions for Form 1040.
1 Donor’s first name and middle initial 2 Donor's last name 3 Social security number
4 Address (number and street) 5 Domicile
6 City, state, and ZIP code 7 Citizenship
<
i] 8 Ifthe donor died during the year, check here ® L] andenterdateofdeath ooo... eee eee ID Le Yes | No
£ 9 Ifyou received an extension of time to file this Form 709, check here ® L] and attach the Form 4868, 2688, | 2350, or extension letter
$10 Ifyou (the donor) filed a previous Form 709 (or 709-A), has your address changed since the last Form 709 (or 709-A) was filed? _.
= 11 Gifts by husband or wife to third parties. —Do you consent to have the gifts (including generation-skipping transfers)
g 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.) .
oO (if the answer is ‘‘Yes,’’ the following information must be ‘furnished and ‘your spouse is isto sign the ‘consent shown below. YY
| |__ Ifthe answer is ‘‘No,”’ skip lines 12-17 and go to Schedule A.)
=t/12 Name of consenting spouse 13 Social security number
5
a

14 Were you married to one another during the entire calendar year? (See instructions.) .
15 If the answer to 14 is ‘‘No,"" check whether C] married LJ divorced or L] widowed, and give date Gee instructions) >
116 Will a gift tax return for this calendar year be filed by your spouse? .

17 Consent of Spouse—! 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.

Consenting spouse's signature > Date >
1 Enter the amount from Schedule A, line 15 . 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 A for the current year in separate instructions) 4
5 Tax computed on amount on line 2 (see Table A for the current year in separate instructions) 5
-| © Balance (subtractline 5 fromline4) . . . . re 6
5] 7 Enter the unified credit from Table B (see instructions) LZ
s 8 Enter the unified credit against tax allowable for all prior periods (from Sch. 'B, line L col. © 8
2) 9 Balance (subtract line 8 from line 7) . 9
EI 10 Enter 20% of the amount allowed as a specific exemption forgitts made: after September 8,
be 1976, and before January 1, 1977 (see instructions). ee ee ee es LO
JS) 11 Balance (subtract line 10 from line 9) a
CY] || 12 Unified credit (enter the smaller of ine 6 or line 11) tee ee ee [2 |
lai] 13 Credit for foreign gift taxes (seeinstructions) © ©. 6 6 ee ee 13
§] 14° Totalcredits(addlines12and13). . . . Lo .. . [a4
| 15 Balance (subtract line 14 from line 6) (do notenter lessthanzero) . . . . . . . . . [38
16 Generation-skipping transfer taxes (from Schedule C, Part4,col.H, total). . . . 2. . 16
17 Total taxes (addlines15and16). . . . . oe. [AZ
18 Gift and generation-skipping transfer taxes prepaid with extension of time to file we... 18
19 Ifline 18is less than line 17, enter BALANCE DUE (see instructions) . . .... . =. {19
20 _Ifline 18 is greater than line 17,enterAMOUNTTOBEREFUNDED. . . . . . . . . (| 20

Please attach the necessary supplemental documents; see instructions.

Under penalties of perjury, | declare that | 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.

Donor’s signature > Date >

Prepater's signature
(other than donor) ® Date >

Please attach check or money order here

Preparer's address.
(other than donor)

For Paperwork Reduction Act Notice, see page 1 of the separate instructions to this form. Form 709 (Rev. 1-87)


Form 709 (Rev. 1-87) Page 2
Seah a.y Computation of Taxable Gifts
Part 1.—Gifts Subject Only to Gift Tax. Gifts less political organization, medical, and educational exclusions—see instructions
A | Donee's name and address and description of gt If the gift was made by means ¢ D E
Item ¢ Donor's adjusted Date Value at
of a trust, enter trust's identifying number below and attach a copy of the trust
number | ‘instrument, If the gift was securities, enter the CUSIP number(s), if available. basis of gift of gift date of gift
1
Part 2.—Gifts Subject to Both Gift Tax and Generation-Skipping Transfer Tax. You must list the gifts in chronological order.
Gifts less political organization, medical, and educational exclusions—see instructions
A | ponee's name and address and description of it the gift was made by means Lf D E
Item | ofa trust, enter trust's identifying number below and attach a copy of the trust Doner's adjusted Dale eaueat
number | instrument. If the gift was securities, enter the CUSIP number(s), if available. a fe! 8
1

Part 3.—Gift Tax Reconciliation

1 Total value of gifts of donor (add column E of Parts 1 and 2) (see instructions) 1
2 One-half of items — attributable to spouse (see instructions) 2
3° Balance (subtract line 2 from line 1) . . 3
4 Gifts of spouse to be included (from Schedule A, Part 3, ‘line 2 ‘of spouse’ 's return—see instructions) . 4
If any of the gifts included on this line are also subject to the generation-skipping transfer tax, check
here » [J and enter those gifts also on Schedule C, Part 1.
5 Total gifts (add lines 3 and 4) . . 5
6 Total annual exclusions for gifts listed on Schedule A (including line 4, above) (see instructions) 6
7 Total included amount of gifts (subtract line 6 from line 5) . 7
Deductions (see instructions)
8 _ Gifts of interests to spouse for which a marital deduction will be claimed,
based on items ofScheduleA . . . | 8
9 Exclusions attributable togiftsonline8. . . 2... 2... LY
10 Marital deduction—subtract line9fromline8 . . . . .. . . . [10
11° Charitable deduction, based on items _._.. 2.2... tol. less exclusions 1
12 Total deductions—add lines 10 and 11. 12
13 Subtract line 12 from line 7. : 13
14 Generation-skipping transfer taxes payable with this Form 709 (from Schedule c, Part 4, col. H, Tota) 14
15__ Taxable gifts (add lines 13 and 14). Enter here and on line 1 of the Tax Computation 15

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Form 709 (Rev. 1-87) Page 3
Sie eaae.y Computation of Taxable Gifts (continued)

16 Terminable Interest (QTIP) Marital Deduction. (See instructions.)
O1 < Check here if you elected, under the rules of section 2523(f), to include gifts of qualified terminable interest property on line 8,
above. Enter the item numbers (from Schedule A) of the gifts for which you made this election >

Sea UeS:y Gifts From Prior Periods

Did you (the donor) file gift tax returns for prior periods? (If “Yes,” see instructions for completing Schedule B below.) Ol Yes T_No
c D
A
B Amount of unified Amount of specific E
Calendar year or Internal Revenue office credit against gift exemption for prior Amount of
Gee instractions) where prior return was filed {axfor periods after | periods ending before taxable gifts

1 Totals for prior periods (without adjustment for reduced specific exemption) 1

2 Amount, if any, by which total specific exemption, line 1, column (D), is more than $30,000 . . . . [2
3 Total amount of taxable gifts for prior periods (add amount, column €), line 1, and amount, if Hany. on line 2).
(Enter here and on line 2 of the Tax Computationon page 1.) . . 3

Sea Reg Computation of Generation-Skipping Transfer Tax
Part 1.—Generation-Skipping Transfers

itemN va spit it be E F Grand ‘s

item No. alue split Gifts andchild Net Transfer

(from Schedule A, | (from Schedule A, | (enter¥of col. 8) | Subtract col. Annual Exclusion Subtract col E Exclusion (subtract col. G
Part 2,col.A) || Part2,col.£) "| (see instructions) Claimed from col. F)

If you elected gift splitting and your
spouse was required tofilea separate | sponeg fants 709
Form 709 (see the instructions for
Split Gifts), you must enter all of the
gifts shown on Schedule A, Part 2, of
your spouse's Form 709 here

In column C, enter the item
number of each gift in the orderit ap- |-
pears in column A of your spouse's
Schedule A, Part 2. We have
preprinted the prefix “S-" to
distinguish your spouse's item
numbers from your own when you
complete column A of Schedule C,
Part 4.

In column D, for each gift, enter

the amount reported in column C, , - -
Schedule C, Part 1, of your spouse's Total grandchild exclusions claimed on this return. Must equal total of column D,

Form 709. Schedule C, Part 2.

Value included
(enter number) "Form 709 .

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