rom 709 United States Quarterly Gift Tax Return

(Rev. December 1980) (Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1976)

Department of the Treasury Calendar quarter(s) ending (March, L)June, [J September, {_] December, 19......... .

Internal Revenue Service For “Privacy Act” notification, see the Instructions for Form 1040.

Donor's first name and middie initial Donor's last name Social security number

Address (number and street) Residence (domicile)

City, State, and ZIP code Citizenship Yes | No

If you (the donor) filed a previous Form 709, has your address changed since the last Form 709 was filed?. . . . .

A Gifts by husband or wife to third parties—Do you consent to have the gifts by you and by your spouse to third parties
during the calendar quarter(s) considered as made one-half by each of you? (See instructions.). . . . . .. . e

(If the answer is “Yes,” the following information must be furnished and your spouse is to sign the consent shown below.
If the answer is “No,” skip lines 1-6 and go to Schedule A.)

_

1(a) Name of consenting spouse 1(b) Social security number

\N |

7

~

7

2 If the consent is effective for gifts made in a previous quarter(s) of the calendar year and no return was filed for such
previous quarter(s) (see instructions) and such gifts are being reported on this return (see instructions), write the
previous quarter(s) ending (month and year) in addition to the current quarter ending (month and year).

3_Were you married during the entire calendar quarter(s)?.. .- «+ + + + + + e+ + + es ee te ee ee

4 If the answer to 3 is “No,” check whether [] married [_] divorced or ["} widowed, and give date (see instructions) >

Ma

5 _Will a gift tax return for this calendar quarter(s) be filed by your spouse?. . woe

& Consent of Spouse—I consent to have the gifts made by me and by my spouse to third parties during the calendar quarter(s) 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 >

1 Enter the amount from Schedule A, line 25. . 2 6 6 ee ew we ee ee
2 Enter the amount from Schedule B, line3. . . «6 6 ee ee ee ee eh

3 Total taxable gifts (add amounts on lines land2). . 2. «© 2 2 6 © ee ee ee

4 Tax computed on amount on line 3 (see Table A in separate instructions). . . . . « « +

5 Tax computed on amount on line 2 (see Table Ain separate instructions). . . . . . « «©

= 6 Balance (subtract amount on line 5 from amount on line4). . . «2 6 ee eh ee

2 7 Enter the amount of unified credit from Table B (see instructions). . . . 2. 2 ee e

2] 8 Enter the amount of unified credit against gift tax allowable for all prior quarters. . . . «+

%
3

rT =| 9 Balance (subtract amount on line 8 from amount on line 7)...» ee + ee ee

iS 10 Enter 20% of the amount allowed as specific exemption after September 8,1976. . . . .

11 Balance (subtract amount on line 10 from amountonline9). . . - 2 1 ee ee ee

12 Unified credit (enter the smaller of amount on line 6 or amount online 11). . 6. 2 2. 8

13 Credit for foreign gift taxes (see instructions). 2. . 2. 6 1 ee ee ee he

14 Total (add amounts on line 12 and line 13). . 6 6 ee ee ee ee ee

15 Tax due (subtract amount on line 14 from amount on line 6) (see instructions)... . . . | 15

Please attach the necessary supplemental documents; see instructions.

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

Donor’s signature > Date >

Under penalties of perjury, 1 declare that | have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief it is true,

Please attach Check or Money Order here

Preparer’s signature
(other than donor) & Date >

Preparers address
(other than donor) >

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Form 709 (Rev. 12-80)

Page 2

isa Computation of Taxable Gifts

Item Donee’s name and address and description of gift. Donors adjusted Date Value at
If the gift was made by means of a trust, enter trust's identifying p te }
number number below and attach a copy of the trust instrument basis of gift of gift date of gift
1
1 Total gifts of donor (see instructions). . 2. 1 ee ee ee ee wee

2 One-half of items ... attributable to spouse (see instructions). . .
3 Balance (subtract amount on line 2 from amountonlinel). . . 1 2 ee ee
4 Gifts of spouse to be included (from line 2 of spouse’s return—see instructions). .
5 Total gifts (add amounts on lines3and4). . . 2. 6 se we ew ew ee ee

6 Total exclusions not exceeding $3,000 for the calendar year for each donee (except gifts of future interests) .

7 Total included amount of gifts (subtract amount on line 6 from amount on line 5). .
Deductions (see instructions):
8 Gift of qualified interests to spouse for this period (before annual exclusion, based on
items . from Schedule A). . rT
9 Annual exclusion attributable to giftsonline8. . 6 6 1 6 ew ee ee
10 Net amount (subtract amount on line 9 from amountonline8). . . . . «+ «
11 First $100,000 marital deduction. . 6 6 6 6 ee ee ee ee
12 Marital deduction for prior periods after December 31,1976. . . . . . ss
13 Balance of first $100,000 marital deduction available (subtract amount on line 12
from amount on line 11, If less than zero, enter zero), . 2 ss + 6 ee ee
14 Excess over first $100,000 marital deduction (if total of amount on line 10 plus
amount on line 12 is $100,000 or less, enter zero. Otherwise, enter amount on line 8
less amount online 13). 0. 6 ww ee ee ee ee ee te
15 Excess over first $100,000 for prior periods (after December 31,1976). . . . «
16 Total excess over first $100,000 (add amounts on lines 14 and 15). . . . .
17 Second $100,000. . . 2. ee ee ee ee ee we eee
18 Gifts qualifying for additional marital deduction (subtract amount on line 17 from

amount on line 16. If less than zero, enter zero). « 2 6 e+ ee ee ee
19 Enter 50% of amount online 18. . 1 ew ee ee ee ee he
20 Enter 50% of amount on line 8 but not more than amountonlinel0. . . . « «
21 Enter the smaller of the amount on line 10 or the amountonline13. . . . . «

22 Marital deduction (if amount on line 18 is zero, enter amount from line 21. Otherwise,
enter amount from line 21 plus the smaller of the amounts on line 19 or line 20). .

23 Charitable, public, and similar gifts (based on items less
exclusions). 2. 2 6 6 8 6 ee ee ee ee ee ee eh
24 Total deductions (add amounts on lines 22 and 23). . - 2 6 ee we ee

25 Amount of taxable gifts (subtract amount on line 24 from amount on line 7) «

$100,000

00,000

Kslola lef

24
25

) clYes [] No

a CMNGIEN Did you (the donor) file gift tax returns for prior periods? (If “Yes,” follow instructions in completing ‘Schedule B below.)

2) ori (b)
Calendar years (prior to Internal Revenue office

1971) and calendar quarters
(1971 and subsequent years)

(c)
Amount of unified
credit against gift
where prior return was filed tax for periods after
December 31, 1976

@

Amount of specific
exemption for prior
periods ending before
January 1, 1977

@
Amount of
taxable gifts

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

2 Amount, if any, by which total specific exemption, line 1, column (d), is more than $30,000 .
3 Total amount of taxable gifts for prior periods (add amount, column (e), line 1, and amount, if any, line 2) .

2

3

(If more space is needed, attach additional sheets of same size.)
‘#¢ US, GOVERNMENT PRINTING OFFICE : 1981~O-313-393,

313-393-1