rom 709 United States Gift Tax Return

(Rev. July 1982) (Section 6019 of the Internal Revenue Code) (For gifts made after December 31, 1981 and before January 1, 1985)

OMB No, 1545-0020
Expires 6-30-85

Department of the Treasury Calendar year 19...
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 Citizenshi,

* P Yes | No
If the donor died during the year, check here > [-] and enter date of death 7,19

If you received an extension of time to file this Form 709, check here > [—] and attach the Form 4868, 2688, 2350 or extension letter.

WY
__

If you (the donor) filed a previous Form 709, has your address changed since the last Form 709 was filed? .

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.) . . oe
(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.)

IS

1(a) Name of consenting spouse 1(b) Social security number

2 Were you married to one another during the entire calendar year?. . . . . ee ee ee

3 If the answer to 2 is ‘‘No,” check whether [_] married ("} divorced or [_] widowed, and give date (see instructions) D>

4 Will a 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 pariies 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 >

1 Enter the amount from Schedule A, line13. 0. 2. ee
2 Enter the amount from Schedule B, line 3 . Po
3 Total taxable gifts (add lines land2). . . . . Po
4 Tax computed on amount on line 3 (see Table A in separate instructions) . 4A
5 Tax computed on amount on line 2 (see Table A in separate instructions) . —s —
6 Balance (subtract line 5 from line 4). 0. 6 ee ee ee | —
7 Enter the unified credit from Table B (see instructions). . . . . ~{-7
§| 8 Enter the unified credit against tax allowable for all prior periods (from Schedule B, line 1(@)) . |_& | _
3
2] 9 Balance (subtract amount on line 8 from amount on line7). . . ee ee | 9
3 10 Enter 20% of the amount allowed as specific exemption after September 8, 1976 and before
rie January 1, 1977 (see instructions). . . . 2 1. eee eee |_10_| —
| 11 Balance (subtract line 10 fromline9). . 2 2 ee ee ee ee ee PD a
12 Unified credit (enter the smaller of line 6 orline11). . 2... 2.) ee ee La
13 Credit for foreign gift taxes (see instructions). . . . . . - 2. ee eee ee |S _
14 Total (add lines 12 and 13). 2 6 1 ee ee ee ee ee |
15 Balance (subtract line 14 from line 6) (do not enter less than zero) . 15 a
16 Gift taxes prepaid with extension of time tofile. ©... 6. ee eee ee ee LO _
17 If line 16 is less than line 15, enter BALANCE DUE. . eo ee ee LEZ
18 If line 16 is greater than line 15, enter AMOUNT TO BEREFUNDED. . . . . . . . . .| a8

Please attach the necessary supplemental documents; see instructions.

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

Donor's signature» Date »

Under penalties of perjury, | 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

Preparer's signature
(other than donor) & Date m

Preparer's address,
(other than donor)»

For Paperwork Reduction Act Notice, see page 1 of the separate instructions to this form.

363-464-1


Form 709 (Rev. 7-82) Page 2
Schedule _A Computation of Taxable Gifts (Gis ress medical and educational exclusions—see instructions)

ruiter|__ What acereey maamersnenrmememmne | Br Pui ooh ota dh
1

1 Total gifts of donor (see instructions). 2 6 6 ee ee ee ee ee ee ee ee LD

2 One-half of items ... attributable to spouse (see instructions). . . . . . _2_|

3 Balance (subtract line 2fromline1). 2. 6 6 ee ee _3_|

4 Gifts of spouse to be included (from line 2 of spouse’s return— see instructions). . . . . . . . . | 4] —

5 Total gifts (add lines 3and4). . . 2. 2 ee soe a _5_|

6 Total annual exclusions for gifts listed on Schedule A (see instructions) . . _6 |

7 Total included amount of gifts, subtract line 6 from line5. . « _7 |

Deductions (see instructions)

8 Gifts of interests to spouse for which a marital deduction will be claimed, based
on items .. . of ScheduleA. 2 6. ee ee

9 Exclusions attributable to gifts online8 . 2 6 ee ee ee

10 Marital deduction—subtract line 9 fromline8. . 2. 6 1 1 ee ee

11 Charitable deduction, based on items ...

12 Total deductions—add lines 10 and 11. 0. 6 1 we we ee ee

13 Taxable gifts (subtract line 12 from line 7) eee

Terminable Interest Marital Deduction. (see instructions)
(0 <4 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..

SRCEIMGMSIN Did you (the donor) file gift tax returns for prior periods? (If “Yes,” see instructions for completing Schedule B below.) [Yes [J No

@ ©) @®
Oy Amount of unified | Amount of specific (e)
Gslendar year or intemal Revenuio office, a ectedit against gift exemption for prior Amount of
where prior return was file ‘ax for periods after | periods ending before taxable gift
(see instructions) December 31, 1976 | P° January 1,1977 pense a’

1 Totals for prior periods (without adjustment for reduced specific exemption) . |_2 I
2 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) |_3

(If more space is needed, attach additional sheets of same size.)
¢ US, GOVERNMENT PRINTING OFFICE : 1882-O-363-466 363-464-1