rorm 709 United States Quarterly Gift Tax Return

(Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1976)
Calendar quarter(s) ending (month and year) >.
Department of the Treasury | For “Privacy Act” notification, see the Instructions for Form 1040.

(Rev. June 1977)

Donor's first name and middle 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 wasfiled?. . . . . + +
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 instruction 8.) . rare 2

(If the answer is “Yes,” the following information must be furnished and the consent shown below signed by your spouse.) || VY,
1(a) Name of spouse 1(b) Social security number |Z

7

LL

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 instruction 1) and such gifts are being reported on this return (see instruction 10), 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)?_. . . . . - + +++ -

4 If the answer to 3 is “No,” check whether [] married, [] divorced, or [-] widowed, and give date >

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IN

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

Consent of Spouse—I consent to have the gifts made by me and by my spouse to third parties during the calendar “quarter « 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.

Spouse's signature p>

1 Enter the amount from Schedule A, line)... . - ee ee ee
2 Enter the amount from Schedule B, line (c) . . . - - . 2 eee

3 Total (add amounts on linesland2). 2... 2. eee 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 A in separate instructions.)

|| 6 Balance (subtract amount on line 5 from amount online 4)... . 1 ee eee

Ss 7 Enter the amount of unified credit from TableB . . . . - se eee |_|

§ 8 Enter the amount of unified credit against gift tax allowable for all prior "quarters . soe ee _ 8 |

2

'3| 9 Balance (subtract amount on line 8 from amount on line 7) re ae
i” £| 10 Enter 20% of the amount allowed as specific exemption after September 8, 1976 rr oe

jo

11 Balance (subtract amount on line 10 from amount on line9) . . .
12 Unified credit (enter the smaller of (i) amount on line 6 or (ii) amount on line 1). .
13 Credit for foreign gift taxes (see instruction 20)... . ee ee ee

14 Total (add amounts on line 12andline 13). 2. 6/1 ee ee ee ee

15 Tax due (subtract amount on line 14 from amount on line 6)... - - - - - WLS

Please attach the necessary supplemental documents; see instruction 15.

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

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

Please attach Check or Money Order here

Donor’s signature b> Date &
Preparer's signature
(other than donor) b> Date bm

Preparers address
[| Gtiter than donor) >



Form 709 (Rev. 6-77)

RirtticaeWs Computation of Taxable Gifts

Page 2

Item Donee's name and address and description of gift. If the gift was, Donor’s adjusted Date of Value at date of
number made by means of a trust, attach a copy of the trust instrument basis of gift gift gift
1

(a) Total gifts of donor. 2

(b) One-half of items .

to. attributable to spouse (see instruction 11). .

(c) Balance (subtract amount on line (b) from amount on line (a)). . . . . - .
(d) Gifts of spouse to be included (from line (b) of spouse's return) (see instruction 1. .
(e) Total gifts (add amounts on lines (c) and (d)). . . . 2 eee a
(f) Total exclusions not exceeding $3,000 for the calendar year for each donee (except gifts of future interests) .
(g) Total included amount of gifts (subtract amount on line (f) from amount on line (e)). .
(h) Deductions (see instructions 16 and 17):

(A)(a)

(b)

(c)
(2)(a)

(b)

(c.

(3)(a)

(b)

«c

)

(4)(a)
(b)

(5)(a)
(b)

(6)

(7)

@ Total.deductions (add amounts on lines. nv6) ‘and mm. :
Amount of taxable gifts (subtract amount on line (i) from amount on line (g))

P schedule B Did you (the donor) file gift tax returns for prior periods? (I

Calendar years (prior to. ;
1971) and calendar quarters| Internal Revenue office where prior return was filed

«c

)

Gift of qualified interests to spouse for this period (before annual exclusion, based on
items . to from Schedule A) . woe

Annual exclusion attributable to gifts on line (h)(1)(a). 2.

Net amount (subtract amount on line (h)(1)(b) from amount on line (yayeay) .
First $100,000 marital deduction. . . see et
Marital deduction for prior periods after December 31, 1976. ee ee

Balance of first $100,000 marital deduction available (subtract amount on line
(h)(2)(b) from amount on line (h)(2)(a) but not less than zero) . .

Excess over first $100,000 marital deduction (if total of amount on line (hy(1)¢6) plus
amount on line (h)(2)(b) is $100,000 or less enter zero. Otherwise, enter amount on
line (h)(1)(a) less amount on line (h)(2)(c)). - ee ee toe
Excess over first $100,000 for prior periods (after December 31, 1976) .

Total excess over first $100,000 (add amounts on lines (h)(3)(a) and (h)(3)(b)) -
Second $100,000
Gifts qualifying for additional marital deduction ‘(eubtract amount on line 2 (hy(4y(a)
from amount on line (h)(3)(c) but not less than zero). . . . . -

Enter 50% of amount on line (h)(4)(b). - . - .

Enter 50% of amount on line (h)(1)(a) but not more 2 than amount on line mare).
Enter the lesser of the amount on line (h)(1)(c) or the amount on line (h)(2)(c) .
Marital deduction (if amount on line (h)(4)(b) is zero, enter amount on line (h)(5)(c)-
Otherwise, enter amount on line (h)(5)(c) plus the lesser of the amounts on line
(h)(5)(a) or line (h)(5)(b)) . eee Coe ee
Charitable, public, and similar gifts (based on items .... .... to less
exclusions) . . . . coe

es,” follow instruction 19 in co

$100,000

$100,000

mpleting Schedule B below.

(] Yes [] No

‘Amount of unified
credit against gift
tax for periods after

(4971 and subsequent years) December 31, 1976

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

Amount of
taxable gifts

(a) Totals for prior periods (without adjustment for reduced specific exemption) .
(b) Amount, if any, by which total specific exemption, line (a), exceeds $30,000 (see instruction 19). . . . =
(c) Total amount of taxable gifts for prior periods (add amount, last column, line (a), and amount, if any, line (b)) «

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