Form 709 (Rev. 12-89)

Page 4

esa Computation of Generation-Skipping Transfer Tax (continued)

Part 2.—Grandchild Exclusion Reconciliation

A B c D E
Maximum. Total of Exclusions. Exclusion Available Exclusion Claimed Exclusion Available
Name of Grandchild Allowable Claimed on Previous for This Return on this Return for Future Returns
Exclusion Returns (subtract col. B from col. A) (subtract col. D from col. C)
$2,000,000

$2,000,000

Total grandchild exclusions claimed on this return. Must equal total of column G, Part 1

Part 3.—GST Exemption Reconciliation (Code section 2631) and Section 2652(a)(3) Election

Check box [1] if you are making a section 2652(a)(3) (special QTIP) election (see instructions)
Enter the item numbers (from Schedule A) of the gifts for which you are making this election > ..
1 Maximum allowable exemption . 1 $1,000,000
2 Total exemption used for periods before filing this return . 2
3 Exemption available for this return (subtract line 2 from line 1) . Soe ee 3
4 Exemption claimed on this return (from Part 4, col. C total, below). . . woe 4
5 Exemption allocated to transfers not shown on Part 4, below. You must attach a 2 Notice of Allocation, (See

instructions.). 6 6 6 ee 5
6 Add lines 4and5 . 6
7__ Exemption available for future transfers (subtract line 6 from line 3. 7
Part 4.—Tax Computation

A B c D E F G 4

Item No. Net transfer GST Exemption | Dividecol.C | Inclusion Ratio Maximum Gift Applicable Rate Generation-Skipping
(from Schedule | (from Schedule C, Allocated bycol.B | (subtract col. D Tax Rate (multiply col. E Transfer Tax

C, Part 1) Part 1, col. H) from 1.000) by col. F) (multiply col. B by col. G)

55% (,55)

55% (.55)
Total exemption claimed. Enter
here and on line 4, Part 3, Total generation-skipping transfer tax. Enter here, on line 14
above. May not exceed line 3, of Schedule A, Part 3, and on line 20 of the Tax x Computation

Part3,above . . . . . on pagel .

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


rom 709 United States Gift (and Generation-Skipping Transfer) Tax Return
(Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1988, and before January 1, 1990) | OMB No. 1545-0020

(Rev. December 1989)
Expires 11-30-92

Department of the Treasury Calendar year 19

Internal Revenue Service > See separate instructions. For Privacy Act Notice, see the Instructions for Form 1040.
1 Donor's first name and middle initial 2 Donor's last name 3 Social security number
4 Address (number and street) 5 Domicile
c
= 6 City, state, and ZIP code 7 Citizenship
—
s 8 Ifthe donor died during the year, check here » LC] and enter date of death Yes | No
£| 9 Ifyou received an extension of time to file this Form 709, check here »(L and attach the Form 4868, 2688, 2350, or extension letter
ro 10 If you (the donor) filed a previous Form 709 (or 709-A), has your address changed since the last Form 709 (or 709-A) was filed?
e 111 Gifts by husband or wife to third parties. —Do you consent to have the gifts (including generation-skipping transfers)
oO made by you and by your spouse to third parties during the calendar year considered as made one-half by each of you?
| (See instructions.) (If the answer is “Yes,” the following information must be furnished and your spouse is to sign the
cal consent shown below. If the answer is ‘‘No,”’ skip lines 12-17 and go to Schedule A.). woe ee
s 12 Name of consenting spouse [13 SSN
114 Were you married to one another during the entire calendar year? (See instructions.)
15 If the answer to 14 is ‘‘No,"’ check whether L] married C1 divorced or L] widowed, and give date (see instructions) >
16 Will a gift tax return for this calendar year be filed by your spouse? . wee
17 Consent of Spouse—! consent to have the gifts (and generation-skipping transfers) made by me and by my spouse to third parties during the calendar year 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 > Date >
1 Enter the amount from Schedule A, Part3,line15 2 2 2 1 ww ee ee ee L
2 Enterthe amount from Schedule B,line3 2. 2 ee ee LO
3 Total taxable gifts (addlinesland2). . . . . 13
4 Tax computed on amount on line 3 (see Table for Computing Tax i in separate instructions) 4
5a_ Enter the lesser of line 3 or $21,040,000 . . . . 5a
b Subtract $10,000,000 from line 5a (do not enter less than ze10) 5b [
c Enter 5%(.05)ofline5b. . . . re a1
6 Total tentative tax on the amount on line 3 (add lines 4 and 5c) . woe ee ee LE
c 7 Tax computed on amount on line 2 (see Table for Computing Tax i in separate instructions) 7
|| 8a Enter the lesser of line 2 or $21,040,000 . . . 8a
8 b Subtract $10,000,000 from line 8a (do not enter less than zer0) 8b
al ¢ Enter5%(.05)ofline8b. . . . . co ee ee | BE
£| 9 Total tentative tax on the amount online 2(addlines7and@e) 2... LS
18} 10 Balance (subtract line 9 fromline6). . . ee
ki 11. Maximum unified credit (nonresident aliens, see instructions) . . (4t 192,800] 00
|| 12 Enter the unified credit against tax allowable for all prior periods (from Sch. B, line 1, col. ro) 12
o|N 13 Balance (subtract line 12 from line 11) . 13
3 $s 14 Enter 20% (.20) of the amount allowed as a specific “exemption for gifts ‘made after
ra September 8, 1976, and before January 1, 1977 (see instructions). . . . . . . . . [34
8] | 15 Balance (subtractline 14fromline13) 2. LB
S| | 16 Unified credit (enter the smaller of line 10 orline 15). - 2. 2 ee ee 16
3 17 Credit for foreign gift taxes (see instructions) . . . . . 2... 2... ss. LZ
2) | 18 Totalcredits(addlines 16and17). . . . . ce ee ee. [18
5 19 Balance (subtract line 18 from line 10) (do not enter less than zero) « tee eee. 9
x 20  Generation-skipping transfer taxes (from Schedule C, Part 4, col.H, total). . . . . . . [20
2 21° Totaltax(addlines19and20). . . . woe ee Led
2 22 Gift and generation-skipping transfer taxes prepaid with extension of time to file woe ey [22
ey 23 Ifline 22 is less than line 21, enter BALANCE DUE (see instructions) . . . . . . . . [23
2 24 _Ifline 22 is greater than line 21, enterAMOUNTTOBEREFUNDED. . . . . . . 24
| _ Under penalties of perjury, | declare that I have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief it
&| true, correct, and complete. Declaration of preparer (ther than donor) s based onal information of which preparer has any knowledge.
& | donor's signature » Date »

Preparer's signature
(other than donor) Date >

Preparer's address
(other than donor) >

For Paperwork Reduction Act Notice, see page 1 of the separate instructions for this form. Form 709 (Rev. 12-89)



Form 709 (Rev. 12-89)

Page 2

Sea eg.y Computation of Taxable Gifts
Part 1.—Gifts Subject Only to Gift Tax. Gifts less political organization, medical, and educational exclusions—see instructions

A B c D E
Item | Donee’s name, relationship to donor (if any), and address and description of Donor's adjusted Date Value at
number | gift. If the gift was made by means of a trust, enter trust's identifying number basis of gift of gift date of gift

below and attach a copy of the trust instrument. If the gift was securities,
enter the CUSIP number(s), if available.
1

Part 2.—Gifts Which are Direct Skips and are Subject to Both Gift Tax and Generation-Skipping Transfer Tax. You must list the gifts
in chronological order. Gifts less political organization, medical, and educational exclusions—see instructions

A B c D
Item | Donee’s name, relationship to donor (if any), and address and description of Donor's adjusted Date
number | gift. If the gift was made by means of a trust, enter trust's identifying number basis of gift of gift

below and attach a copy of the trust instrument. If the gift was securities,
enter the CUSIP number(s), if available.

E
Value at
date of gift

Part 3.—Gift Tax Reconciliation

1 Total value of gifts of donor (add column E of Parts 1 and 2) ro
2 = One-half of items __------- eee attributable to spouse (see instructions) 2
3 Balance (subtract line 2 from line 1) . . 3
4 Gifts of spouse to be included (from Schedule A, Part 3, ‘line 2 of spouse’ "Ss return—see instructions). 4
If any of the gifts included on this line are also subject to the generation-skipping transfer tax, check
here » (] andenter those gifts also on Schedule C, Part 1.
5 Total gifts (add lines 3 and 4) . . 5
6 Total annual exclusions for gifts listed on Schedule A (including line 4, above) ‘(see instructions). 6
7 Total included amount of gifts (subtract line 6 from line 5) 7
Deductions (see instructions)
8 Gifts of interests to spouse for which a marital deduction will be claimed,
based on items . of Schedule A 8
9 Exclusions attributable to gifts on line 8 . soe 9
10 Marital deduction—subtract line9fromline8 . . . . . . .. . [10
11 Charitable deduction, based on items less exclusions i
12 Total deductions—add lines 10 and 11. 12
13 Subtract line 12 fromline7. . . 13
14 Generation-skipping transfer taxes payable with this Form 709 (from Schedule ¢, Part 4, col. H, Total) 14
15 Taxable gifts (add lines 13 and 14). Enter here and on line 1 of the Tax Computation on page 1 . 15

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


Form 709 (Rev. 12-89)

Page 3

Sia Rsy §=§=Computation of Taxable Gifts (continued)

16 Terminable Interest (QTIP) Marital Deduction. (See instructions.)
O < Check here if you elected, under the rules of section 2523(f), to include gifts of qualified terminable interest property on line 8,

on page 2. Enter the item numbers (from Schedule A) of the gifts for which you made this election ® __

See} Gifts From Prior Periods
Did you (the donor) file gift tax returns for prior periods? (If “Yes,” see instructions for completing Schedule B below.) . Ol Yes O_o
Cc D
A ;
8 Amount of unified ‘Amount of specific E
Calendar year or Internal Revenue office credit against gift ‘exemption for prior Amount of
a where prior return was filed tax for periods after periods ending before taxable gifts

(See instructions)

December 31, 1976 January 1, 1977

1 Totals for prior periods (without adjustment for reduced specific exemption] 1

Nn

Amount, if any, by which total specific exemption, line 1, column D, is more than $30,000 . . . . {2
3 Total amount of taxable gifts for prior periods (add amount, column E, line 1 and amount, if any, on line 2)
(Enter here and on line 2 of the Tax Computation on page 1.) eee ae 3

Ste eey §=Computation of Generation-Skipping Transfer Tax
Note: /nter vivos direct skips which are completely excluded by the grandchild exclusion and/or the GST exemption

must still be fully reported (including value and exclusions and exemptions claimed) on Schedule C.

Part 1.—Generation-Skipping Transfers
wert B c D E F G H
item No. Value Split Gifts , Grandehild Net Transfer
(from Schedule A, | (from Schedule A, | (enter ¥2 of col. B) | Subtract col. C Annual Exclusion Subtract col, E Exclusion (subtract col. G
Part 2, col. A) Part 2, col. E) (see instructions) 7 . Claimed from col. F)

Ifyou elected gift splitting and your
spouse was required to file a separate
Form 709 (see the instructions for
“Split Gifts”), you must enter all of
the gifts shown on Schedule A, Part
2, of your spouse's Form 709 here

In column C, enter the item
number of each gift in the order it ap-
pears in column A of your spouse's
Schedule A, Part 2. We have
preprinted the prefix "S-” to
distinguish your spouse's item
numbers from your own when you
complete column A of Schedule C,
Part 4,

In column D, for each gift, enter
the amount reported in column C,
Schedule C, Part 1, of your spouse's
Form 709.

Value included
from spouse's
Form 709

Split gifts from
spouse's Form 709
(enter item number)

Total grandchild exclusions claimed
Schedule C, Part 2.

on this return. Must equal total of column D,

(if more space is needed, attach

additional sheets of same size.)