rom 709 United States Gift Tax Return

(Rev. June 1985) (Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1981, and before January 1, 1988) OMB No. 1545-0020
Department of the Treasury Calendar year 19 _ Expires 4-30-88
Internal Revenue Service > For “Privacy Act” Notice, see the Instructions for Form 1040.

Donor's first name and middle initial Donor's last name Social security number

Address (number and street) Domicile

City, State, and ZIP code Citizenship

If the donor died during the year, check here ® L] andenterdateofdeath _....... AD
If you received an extension of time to file this Form 709, check here » L] and attach the Form 4868, 2688, 2350 or extension letter.
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?

Yes | No

A Gifts by husband or wife to third parties.—Do you consent to have the gifts 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 consent shown below.
If the answer is ‘‘No,"’ skip lines 1-5 and go to Schedule A.)

1a Name of consenting spouse 1b Social security number

2 Were you married to one another during the entire calendar year? (see instructions) .

3__ Ifthe answer to 2 is ‘‘No,"" check whether [1] married LI divorcedor CL] widowed, and give date (see instructions) >
4 Willa gift tax return for this calendar year be filed by your spouse? .

5 Consent of Spouse—I consent to have the gifts 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 Enterthe amount from ScheduleA,linel13. 2. 2 2 ew ee ee ee 1
2 Enter the amount from Schedule B, line 3 2
3 Total taxable gifts(addlinesland2). . . . Soe ee 3
4 Tax computed on amount on line 3 (see Table A in separate instructions) rs 4
5 Tax computed on amount on line 2 (see Table A in separate instructions) 5
6 Balance (subtract line 5fromline4) ©. 6 ee 6
5 7 Enter the unified credit from Table B (see instructions) oe . 7
%| 8 Enter the unified credit against tax allowable for all prior periods (from Sch. 'B, line1, col. © 8
5
£] 9 Balance (subtract line 8 fromline7). . . . . . . 9
3) 10 Enter 20% of the amount allowed as specific exemption after September 8, 1976, and before
T x January 1,1977(seeinstructions) . 2 2 2 6 1 ee ee 10
IF) 11 Balance (subtractline 10 fromline9) . . 2. ee ee ee eee LD
12 Unified credit (enter the smaller of line 6 or line 1). Co ee ee ee ee E22
13 Credit for foreign gifttaxes (see instructions) . . 2... 1 ee ee ee ee 13
14 Totalcredits(addlines12and13), . 2... eee ee ee ee ee ee LM
15 Balance (subtract line 14 from line 6) (do notenterlessthanzero) . . . 2... 2 we 15
16 Gift taxes prepaid with extension of timetofile. . . . wee ee es LS
17. Ifline 16 is less than line 15, enter BALANCE DUE (see instructions) . . . . . . . . [47
18 Ifline 16 is greater than line 15,enterAMOUNTTOBEREFUNDED, . . . . . . . . | 18

Please attach the necessary supplemental documents; see instructions.

Under penaities of perjury, I declare that | have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct, and complete. Declaration of preparer (other than donor) is based on all information of which preparer has any knowledge.

Donor’s signature Date >

Preparer’s signature
(other than donor) Date >

Please attach check or money order here

Preparer’s address
(other than donor)

For Paperwork Reduction Act Notice, see page 1 of the separate instructions to this form. Form 709 (Rev. 6-85)


Form 709 (Rev. 6:85) Page 2
SCHEDULE A.—Computation of Taxable Gifts Gifts less political organization, medical and educational exclusions—see instructions

Donee's name and address and description of gift. If the gift was made by means. ,
vin] Satna fie ceeuainaraanetSpuaeinences | tate sek avec
1
1 Total gifts of donor (see instructions) So 1
2 = One-halfofitems _________......._- attributable to spouse (see instructions) 2
3 Balance (subtract line 2 from line 1) . a . 3 |
4 Gifts of spouse to be included (from Schedule A, line 2 of spouse's 's return—see instructions) 4
5 Total gifts (add lines 3 and 4) . . 5
6 Total annual exclusions for gifts listed on Schedule A (including line 4) (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,
basedon items _._.......22--. 2. ofScheduleA. 2... 2 2 | 8
9 Exclusions attributable to gifts on line 8 . 9
10 Marital deduction—subtract line 9 from line 8 o 2... [eo
11 Charitable deduction, based on items to _ less exclusions 11
12 Totaldeductions—addlines10and11. 2... 2.) ee ee ee ee (2
13__ Taxable gifts (subtractline12fromline7). . . . . ee

Terminable Interest Marital Deduction. (See instructions.)
0 < Check here if you elected, under the rules of section 2523(f), to include gifts of qualified terminable interest property on line 8,
above. Enter the item numbers (from Schedule A, above) of the gifts for which you made this election >

SCHEDULE B.— Did you (the donor) file gift tax returns for prior periods? (If “Yes,” see instructions for completing Schedule B below.) [] Yes O_No
@ (b) Amount srunifed ‘Amount 9 speci Oy
mount of unifie mount of specific C
Calendar year or Internal Revenue office credit against gift exemption for prior Amount of
ein traction) where prior return was filed tax for periods after periods ending before taxable gifts
(see inst December 31, 1976 January 1, 1977

1 Totals for prior periods (without adjustment for reduced specific exemption)| 1
2 Amount, if any, by which total specific exemption, line 1, column (d), is more than $30,000
3 Total amount of taxable gifts for prior periods (add amount, column (e), line 1, and amount, if any, online 2) .| 3

ny

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