rom 7ZO6NA United States Estate (and Generation-

(Rev. April 1989) Skipping Transfer) Tax Return OMB No, 1545-0531
Department ofthe Treasury Estate of nonresident not a citizen of the United States Expires 06-30-91
Internal Revenue Service (Section references are to the Internal Revenue Code.)

Attach supplemental documents and translations. Show amounts in United States dollars.
GEM] —_Decedent, Executor, and Attorney

a Decedent's first name and middle initial b Decedent's last name 2 U.S. social security number (if any)
3 Place of death 4 Domicile at time of death 5 Citizenship (nationality) | 6 Date of death
7a Date of birth b Place of birth 8 Business or occupation
‘9a Name of executor [10a Name of attorney for estate
{n
United |b Address b Address
States
lla Name of executor l12a Name of attorney for estate
Outside
United b Address b Address
States
| Part 11 | Tax Computation
1 Taxable estate (from Schedule B, line 8) 1
2 Total taxable gts of tangible or intangible property located in the U.S., ‘transferred (directly or indirectly)
by the decedent after December 31, 1976, and not included in the gross estate (see section 2511) 2
3 Total (add lines 1 and 2). : 3
4 Tentative tax on the amount on line 3 (see instructions) . 4
5 Tentative tax on the amount on line 2 (see instructions) . 5
6 Gross estate tax (subtract line 5 from line 4) . 6
7 Unified credit—enter lesser of line 6 amount or maximum allowed (ce instructions) : 7
8 Balance (subtract line 7 from line 6) . . 8
9 Credit for state death taxes (see instructions and attach: cred it evidence) . 9
10 Balance (subtract line 9 fromline8). . . _ 10
11 Credit for Federal gift taxes (see sections 2102 and ‘2012 and attach computation) | 11
12 Credit for tax on prior transfers (attach Schedule Q, Form 706). . . . 12 Mi
13 Total(addiinesiiand12). . 0. 2 ee PB
14 Netestate tax (subtract line 13 fromline 10)... Co 14
15 Total generation-skipping transfer tax (attach Schedule R, Form 706) . Loe rere ae 5)
16 Section 4980A increased estate tax (attach Schedule S (Form 706)(see instructions)). te es [6
17 Total transfer taxes (add lines 14,15,and16). 2 2 ee
18 Earlier payments (see instructions and attach explanation) . . . . . . 18 ]/
19 U.S. Treasury bonds redeemedtopayestatetax. ©. . 2. 2. 2 ees 19 Uh
20 Total(addlines18and19) 2 ee PO
21 Balance due (subtract line 20 from line 17) (see instructions)... 21

Under penalties of perjury, | declare that I have examined this return, including any additional sheets ‘ached, andto the Best of my. 7 enowiedge ‘and belief, itis true, correct, and
gomplete T understand that a complete return requires listing all property constituting the part of the decedent's gross estate (as defined by the statute) situated in the United
tates.

(Signature of preparer (other than executor) (Address) (ate)

For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Form ZO6NA (Rev. 4-89)


Form 706NA (Rev. 4-89)

Page 2

Part ll General Information

Yes|No| 7 Did the decedent make any transfer (of property _Yes | No
la Did the decedent die testate? . . that was located in the U.S. at either the time of
b Were letters testamentary or of administration the transfer or the time of death) described in
granted fortheestate? . . . . sections 2035, 2036, 2037, or 2038 (see the in-
If granted to persons other than those filing the structions for Form 706, Schedule G)? .
return, include names and addresses on page 1. If 'Yes,"' attach Schedule G, Form 706.
2 Did the decedent, at the time of death, own any: 8 At the date of death, were there any trusts in ex-
a Real property locatedintheU.S.2? . . . . . istence that were created by the decedent and
b US. corporate stock? . . that included property located in the U.S. either
c Debt obligations of (1) a U.S. person, or or (2) the when the trust was created or when the dece-
U.S., a state or any political subdivision, or the dentdied? . . .
District of Columbia?. . . wee ee If “Yes,” attach Schedule G Form 706. Yj
d_Otherpropertylocatedinthe U.S? 1. 9 Atthe date of death, did the decedent:
3 Was the decedent engaged in business in the a Have a general power of appointment over any
US.atthedateofdeath? . . . . . . . property located in the U.S.?

4 At the date of death, did the decedent have
access, personally or through an agent, to a safe

b Or, at any time, exercise or release the power?
If Yes" to either a or b, attach Schedule H, Form 706. Wf

deposit boxlocatedintheUS.? . . 10a __ Have Federal gift tax returns ever been filed?

5 At the date of death, did the decedent own any
property located in the U.S. as a joint tenant with b Periods covered >
right of survivorship; as a tenant by the entirety;

or, with surviving spouse, as community al c__Internal Revenue offices where filed >
Property? . 11 Does the gross estate in the United States
if""Yes,"’attach Schedule E, Form 706. include any interests in property transferred to a
6a Had the decedent ever been a citizen of the “skip person” as defined in the instructions to
United States?. . . Schedule R of Form 706? . .
b_ if “Yes,” did the decedent lose U.S. citizenship If “Yes,” attach Schedules R and/or R- 1, "Form

within 10 yearsofdeath? . . . . 706.

Schedule A_ Gross Estate in the United States Gee instructions)

Yes

No

Do you elect to value the decedent's gross estate at a date or dates after the decedent's death (as authorized by section 2032)?

To make the election, you must check this box ‘‘Yes."’ If you check ‘‘Yes,”’ complete columns (c), (d), and (e). If you check
“‘No,”’ complete column (e). You may leave columns (c) and (d) blank or you may use them to expand your column (b) description.

(a) (b) (c) (d) (e)
Item Description of property and securities Alternate Alternate value in Value at date of death
no. For securities, give CUSIP number, if available. valuation date U.S. dollars In U.S. dollars

1

(If you need more space, attach additional sheets of same size.)
Total.

Schedule B Taxable Estate
You must document lines 2 and 4 for the deduction on line 5 to be allowed.

Gross estate in the U.S. (Schedule A total)

Gross estate outside the U.S. (see instructions) .

Entire gross estate wherever located (add amounts on lines 1 and 2).

Amount of funeral expenses, administration expenses, decedent's debts, mortgages and liens, and losses

during administration (attach itemized schedule) (see instructions) .

Deduction for expenses, claims, etc. (divide line 1 by line 3 and multiply the result by line 4) (sce instructions)
6 Charitable deduction (attach Schedule O, Form " 706) and marital deduction (attach $ Schedule M, Form

706, and computation). . . os . .

7 Total deductions (add lines 5 and 6) *
8 Taxable estate (subtract line 7 from line 1)

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