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Form 706-NA (Rev. 6-2019) Page 2
Part III General Information
Authorization to receive confidential tax information under Regulations section 601.504(b)(2), to act as the estate’s representative before
the IRS, and/or to make written or oral presentations on behalf of the estate:
Name of representative (print or type) License state Address (city or town, state or province, country, and ZIP or foreign postal code)
I declare that I am the attorney/ certified public accountant/ enrolled agent/ other representative (check the applicable
box) for the executor. If licensed to practice in the United States, I am not under suspension or disbarment from practice before the Internal
Revenue Service and am qualified to practice in the state shown above. If not licensed to practice in the United States, check here.
Signature CAF number Date Telephone number
Yes No Yes No
1a Did the decedent die testate? . . . . . 7 Did the decedent make any transfer (of
b Were letters testamentary or of administration property that was located in the United States
granted for the estate? . . . . . . . at either the time of the transfer or the time of
death) described in section 2035, 2036, 2037,
If granted to persons other than those filing the or 2038? See the instructions for Form 706,
return, include names and addresses on page 1. Schedule G . . . . . . . . . . .
2 Did the decedent, at the time of death, own any: If “Yes,” attach Schedule G, Form 706.
a Real property located in the United States? . 8 At the date of death, were there any trusts in
b U.S. corporate stock? . . . . . . . . existence that were created by the decedent
c Debt obligations of (1) a U.S. person; or (2) the and that included property located in the
United States, a state or any political United States either when the trust was
subdivision, or the District of Columbia? . created or when the decedent died? . . .
d Other property located in the United States? . If “Yes,” attach Schedule G, Form 706.
3 Was the decedent engaged in business in the 9 At the date of death, did the decedent:
United States at the date of death? . . . a Have a general power of appointment over
4 At the date of death, did the decedent have any property located in the United States? .
access, personally or through an agent, to a b Or, at any time, exercise or release the power?
safe deposit box located in the United States? If “Yes” to either a or b, attach Schedule H,
5 At the date of death, did the decedent own Form 706.
any property located in the United States as a 10a Have federal gift tax returns ever been filed? .
joint tenant with right of survivorship; as a ▶
tenant by the entirety; or, with surviving b Periods covered
spouse, as community property? . . . . c IRS offices where filed ▶
If “Yes,” attach Schedule E, Form 706. 11 Does the gross estate in the United States
6 a Had the decedent ever been a citizen or resident include any interests in property transferred to
of the United States? See instructions . . . a “skip person” as defined in the instructions
b If “Yes,” did the decedent lose U.S. citizenship or for Schedule R of Form 706? . . . . .
residency within 10 years of death? See instructions If “Yes,” attach Schedules R and/or R-1, Form 706.
Schedule A. Gross Estate in the United States (see instructions) Yes No
Do you elect to value the decedent’s gross estate at a date or dates after the decedent’s death (as authorized by section 2032)? ▶
To make the election, you must check this box ‘‘Yes.’’ If you check ‘‘Yes,’’ complete all columns. If you check ‘‘No,’’ complete
columns (a), (b), and (e); you may leave columns (c) and (d) blank or you may use them to expand your column (b) description.
(a) (b) (c) (d) (e)
Item Description of property and securities Alternate Alternate value in Value at date of
no. For securities, give CUSIP number valuation date U.S. dollars death in U.S. dollars
(If you need more space, attach additional sheets of same size.)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule B. Taxable Estate (Caution: You must document lines 2 and 4 for the deduction on line 5 to be allowed.)
1 Gross estate in the United States (Schedule A total) . . . . . . . . . . . . . . . . . 1
2 Gross estate outside the United States (see instructions) . . . . . . . . . . . . . . . 2
3 Entire gross estate wherever located. Add amounts on lines 1 and 2 . . . . . . . . . . . 3
4 Amount of funeral expenses, administration expenses, decedent’s debts, mortgages and liens, and
losses during administration. Attach itemized schedule (see instructions) . . . . . . . . . . 4
5 Deduction for expenses, claims, etc. Divide line 1 by line 3 and multiply the result by line 4 . . . . 5
6 Charitable deduction (attach Schedule O, Form 706) and marital deduction (attach Schedule M, Form
706, and computation) . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 State death tax deduction (see instructions) . . . . . . . . . . . . . . . . . . . 7
8 Total deductions. Add lines 5, 6, and 7 . . . . . . . . . . . . . . . . . . . . . 8
9 Taxable estate. Subtract line 8 from line 1. Enter here and on line 1 of Part II . . . . . . . . . 9
Form 706-NA (Rev. 6-2019)
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