Form 706-A United States Additional Estate Tax Return OMB No. 1545-0016

(Rev. May 1982) (To report dispositions or cessations of qualified use under section 2032A of Expires 10-31-84

Department of the Treasury tevenue Cor
Internal Revenue Service the Internal R e te)

Name of qualified heir or heiress Heir’s or heiress’ social security number

Address of qualified heir or heiress (number and street including apartment number or rural route) | Commencement Date (See

instructions)

City, town or post office, State, and ZIP code

Decedent's name reported on Form 706 Decedent’s social security number Date of death

Tax Computation

1 Value at date of death (or alternate valuation date) of specially valued property which passed from decedent

Y
to qualified heir or heiress: )
(a) Without section 2032A election. . 2 2. 2 ee ee ee ee ee | AED),

Yj

(b) With section 2032A election. © 2. ee eee ee ee ee LA)
(c) Balance (subtract line 1(b) from line 1(a)). . 2. ee ee ee Soe ee ee .
2 Value at date of death (or alternate valuation date) of all specially valued property in n decedent's estate: 7
(a) Without section 2032A election. . 0. ee ee ee ee [2D | |
(b) With section 2032A election. . 2 6. ee ee ee ee ew ee LCD) Y
(c) Balance (subtract line 2(b) from line 2(a)). - ee ee Zo en
3 Decedent's estate tax: Y
(a) Recomputed without section 2032A election (attach computation). . . . .|_3¢a)| _
(b) Reported on Form 706 with section 2032A election. . . . . . . « « «L3Cb) YA,
(c) Balance (subtract line 3(b) from line 3(a)). . . we ee ee ee ee .
4 Divide line 1(c) by line 2(c) and enter the result asa percentage. . . 2. 2 ee ee ee ee PA
5 Multiply line 3(c) by percentage on line4. . . . : Loe res
6 Additional estate tax imposed for previous dispositions or cessation of qualitied use of portion of same
specially valued property. . 2. ee ee ee ee ee ee ee ee ee _—_—
7 Balance (subtract line 6 from line 5). . 2 1 1 ee ew ee ee ee ee ee
8 Enter the total of column (d), Schedule A, page2..... ee eee |e 7 |
9 Enter the total of column (e), Schedule A, pagge2. . . . . ee ee es el
10 Balance (subtract line 9 from line 8). . Ce
11 Additional estate tax. Enter the lesser of line Z or tine lo. .

HZ Involuntary Conversions or Exchanges. Check if for [7] Involuntary conversion [1] Exchange

12 Qualified replacement (or exchange) property

(a) Item (b) Description (c) Cost (or FMV)
Total cost (or FMV)... . : rr OF © —
13 Enter the total of column (d), Schedule A page 2. ee ee ee ee [BY
14 Divide line 12 by line 13 and enter the resultas a percentage. . . 2. 1 ee ee ee 14
15 Multiply line 14 bylinel1. . . . . we tone . rs © —
16 Additional tax, subtract line 15 from line 11 (Do not enter less than zero)... . . . . . ) . , 196

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

igi ‘Address (and ZiP code) "Date

prep: al

xpayer

For Paperwork Reduction Act Notice, see page 1 of the separate instructions. 363-452-1


Form 706-A (5-82)

Page 2

Schedule A.—Disposition of Specially Valued Property or Discontinuance of Qualified Use

Amount received (or fair

Item | Description of specially valued property and schedule and | Date of disposition (or date ived (0 Special use value.
number | item number where reported on the decedent's Form 706 | qualified use ceased) | TM#FKet value if applicable) ‘See instructions
(a) (b) (e) @) (e)
1
Enter total of column (d) on line 8, page 1, and total of column (e) on line 9, page 1.
‘CUS, GOVERNMENT PRINTING OFFICE: 1982-0-369-452 363-452-1