Form 706-A (Rev 9-88)

Page 4

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

Each transferee must enter into an agreement to be personally liable for any additional taxes imposed by section 2032A(c) and the

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

Last name First name Middle initial
Transferee Social security number Relationship to the qualified heir(ess)
Description of property transferred:
A B c
Item Description of specially valued property and schedule and item Date of
number number where reported on the decedent's Form 706 disposition
1
Last name First name Middle initial
Transferee #2: Social security number Relationship to the qualified heir(ess)
Description of property transferred:
A B c
Item Description of specially valued property and schedule and item Date of
number number where reported on the decedent's Form 706 disposition
1

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


rom 1O6-A United States Additional Estate Tax Return

(To report dispositions or cessations of qualified use under OMB No. 1545-0016

(Rev. September1988)

section 2032A of the Internal Revenue Code) Expires 11-30-90

Department of the Treasury
Internal Revenue Service For Paperwork Reduction Act Notice, see page 1 of the separate instructions.

General Information
Ja Name of qualified heir or heiress 2 Heir's or heiress’ social security number
1b Address of qualified heir or heiress (number and street including apartment number or rural route) ‘3 Commencement date (See instructions)
Je 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

1 Value at date of death (or alternate valuation date) of all specially valued property which passed from
decedent to qualified heir or heiress:

a Without section 2032A election. . . . 2... ... . {da

b With section 2032A election. . 2 2 2. 2 1... LM

¢ Balance (subtract line 1b from line 1a) . . wee ee ple
2 Value at date of death (or alternate valuation date) of all specially valued property i in decedent's estate:

a Without section 2032A election. . . . ........ .{ 2a

b With section 2032A election. . . . . re a)

¢ 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 . . . . . . .L3b

¢ Balance (subtract line 3b from line 3a) . Soe 3c
4 Divide line 1c by line 2candentertheresultasapercentage. . . ..........,.,C4 %
5 Total estate tax saved (multiply line 3c by percentage on line 4) . oe 5
6 Value, without section 2032A election, at date of death (or alternate

valuation date) of specially valued property shownonScheduleA . . . 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) 7064 A (attach copies of. 706- -A) : 9
10 Remaining estate tax savings (subtract line 9 from line SXdo not enter less than zero) . 10
11 Enter the lesser of line 8 or line 10 fa a Fr : 11
12 Enter the total of column D, Schedule A, page 2 Pr 12
13 Enter the total of column, ScheduleA,page2 . . . . 2... . L13
14 Balance (subtractline13fromlinel2). 2. 2... ee. L4
15 Enter the lesser ofline 1lorline14 ._. 15

If the taxable event occurred more than 120 months ‘after the commencement date, complete lines 16- 19. If the taxable event occurred
within 120 months after the commencement date, skip lines 16-18 and enter the amount from line 15 on line 19.

16 Enter the number of full months after the commencement date in excess of 120 months (10 years) when

the qualified heir or heiress disposed of the interest or discontinued the qualifieduse . . . . . . . [16
17 Dividelinel6by60 2 2 ee La
18 Multiply line 15 byline17 . . ee £ }
19 Subtract line 18 from line 15 (do not enter less ‘than zero) . _ 19

If you completed Schedule B, complete lines 20-23. If you did not complete Schedule B, skip Tines 202 22 and enter the amount from line
19 online 23.

20 Enter the total cost (or FMV) fromScheduleB. . . . woes «120
21 Divide line 20 by line 12 and enter the result as a percentage (do not enterr more than 100%) soe oe £21 %
22 Multiply line 19 by percentage online21 . . . soe ee ee ee £22,
23 Additional estate tax, subtract line 22 from line 19 (Dor not enter less than zero) - os | 23

Under penalties of perjury, | declare that I have examined this return, and to the best of my knowledge and belief, itis true, correct, and complete. Declaration of preparer
other than taxpayer is based on all information of which preparer has any knowledge.



Form 706-A (Rev. 9-88) Page 2
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 E
tem Description of specially valued property and schedule and item Date of disposition Amount received (or fair Special use value
number ‘number where reported on the decedent's Form 706 (or date qualified use ceased) | market value if applicable) See Instructions
See Instructions
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-A (Rev. 9-88)

Page 3

Schedule B.—Involuntary Conversions or Exchanges

Check if for:

oO Involuntary conversion oO Exchange

Qualified replacement (or exchange) property

A

Item

B
Description

c
Cost (or FMV)

Total cost (or FMV) (enter here and on line 20 of the Tax Computation)