Form  706-QDT                                              U.S. Estate Tax Return for 
(Rev. June 2019)                                           Qualified Domestic Trusts                                                   OMB No. 1545-1212
Department of the Treasury                                            Calendar Year
Internal Revenue Service        ▶ Go to www.irs.gov/Form706QDT for instructions and the latest information.
Part I     General Information
1a     Name of trust                                                                                             1b   EIN of trust

2a     Name of trustee/designated filer (see instructions)                                                       2b   SSN or EIN of trustee/designated filer

2c     Address of trustee/designated filer

3a     Name of surviving spouse (see Definitions in the instructions)                                            3b   TIN of surviving spouse

3c     Surviving spouse’s date of death (if applicable)                                                          3d   Surviving spouse’s current marital status

4a     Name of decedent                                                   4b   SSN of decedent                   4c   Decedent’s date of death

Part II    Elections by the Trustee/Designated Filer (see instructions)
Please check the “Yes” or “No” box for each question.                                                                                                         Yes No
1      Do you elect alternate valuation?  .             .  . . .      . . . .     . . . . .    . .  . .        . .    . . .       .  .  . .
2      Do you elect special use valuation?  .              . . .      . . . .     . . . . .    . .  . .        . .    . . .       .  .  . .
       If “Yes,” you must complete and attach Schedule A-1 of Form 706.
3      Do you elect to pay the taxes in installments as described in section 6166?  .            .  . .        . .    . . .       .  .  . .
       If “Yes,” you must attach the additional information described in the instructions.
       Note: By electing section 6166, you may be required to provide security for estate tax deferred under 
       section 6166 and interest in the form of a surety bond or a section 6324A lien.
4      If the surviving spouse has become a U.S. citizen, does he or she elect under section 2056A(b)(12)(C) to treat all prior 
       taxable distributions as taxable gifts and to treat any of the decedent’s unified credit applied to the QDOT tax on 
       those distributions as the surviving spouse’s unified credit used under section 2505? (If not a U.S. citizen, enter “N/A”)
Part III   Tax Computation
1      Current taxable trust distributions (total from Part II of Schedule A)  .        . .    . .  . .        . .    . . .            1
2      Value of taxable trust property at date of death (if applicable) (total from Part III of Schedule A) .           . .            2
3      Add lines 1 and 2  .     .    .    . .    .      .  . . .      . . . .     . . . . .    . .  . .        . .    . . .            3
4      Charitable and marital deductions. See Schedule B instructions (total from col. D, Part IV of Sch. A)  .                        4
5      Net tentative taxable amount. Subtract line 4 from line 3  .               . . . . .    . .  . .        . .    . . .            5
6      Prior taxable events (total from Part I of Schedule A) .           . .     . . . . .    . .  . .        . .    . . .            6
7      Taxable estate of the decedent. See instructions .               . . .     . . . . .    . .  . .        . .    . . .            7
8      Add lines 6 and 7  .     .    .    . .    .      .  . . .      . . . .     . . . . .    . .  . .        . .    . . .            8
9      Add lines 5 and 8  .     .    .    . .    .      .  . . .      . . . .     . . . . .    . .  . .        . .    . . .            9
10     Recomputation of decedent’s estate tax based on the amount on line 9. See instructions. Attach
       computation .        . . .    .    . .    .      .  . . .      . . . .     . . . . .    . .  . .        . .    . . .          10
11     Recomputation of decedent’s estate tax based on the amount on line 8. See instructions. Attach
       computation .        . . .    .    . .    .      .  . . .      . . . .     . . . . .    . .  . .        . .    . . .          11
12     Net estate tax. Subtract line 11 from line 10           .      . . . .     . . . . .    . .  . .        . .    . . .          12
13     Payment made with request for extension, if any, and credit under section 2056A(b)(2)(B)(ii) .                 . . .          13
14     Tax due. (If the amount on line 12 exceeds the amount on line 13, enter the difference here.)  .                 .  ▶         14
15     Overpayment. (If the amount on line 13 exceeds the amount on line 12, enter the difference here.)  .                          15
Under penalties of perjury, I declare that I have examined this return, along with accompanying schedules and statements, and to the best of my knowledge and belief, it is 
true, correct, and complete. Declaration of preparer (other than trustee or designated filer) is based on all information of which preparer has any knowledge.
Sign     ▲                                                                                          ▲
Here       Signature                                                                                  Date
           Print/Type preparer’s name                        Preparer’s signature              Date                Check          if   PTIN
Paid                                                                                                               self-employed
Preparer   Firm’s name      ▶                                                                                    Firm’s EIN  ▶
Use Only                      ▶                                                                                  Phone no.
           Firm’s address  
For Paperwork Reduction Act Notice, see the separate instructions for this form.               Cat. No. 12292E              Form 706-QDT (Rev. 6-2019)

Form 706-QDT (Rev. 6-2019)                                                                                                         Page 2
Schedule A    Complete Schedule A only if you are a designated filer filing this return for multiple trusts.

Part I   Summary of Prior Taxable Distributions
         A                                  B                                    C                                D  
         Year                            Amount                                 Year                           Amount
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $

Total. Combine columns B and D  .        .  .        . .   . .   . .    . . . . . .  .    .         ▶

Part II  Summary of Current Taxable Distributions
         A                                  B                                    C                                D  
       EIN of QDOT             Total Taxable Distributions for the Year       EIN of QDOT              Total Taxable Distributions for the Year
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $
                               $                                                                       $

Total. Combine columns B and D  .        .  .        . .   . .   . .    . . . . . .  .    .         ▶

Part III Summary of Property Remaining in QDOTs at Death of Surviving Spouse
         A                     B Alternate Valuation         C                   D                     E Alternate Valuation  F  
       EIN of QDOT             Date (if applicable)        Value              EIN of QDOT              Date (if applicable)   Value
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $
                                                     $                                                                       $

Total. Combine columns C and F         . .  .        . .   . .   . .    . . . . . .  .    .        . . . . . . .  ▶

Part IV  Summary of Marital and Charitable Deductions
         A                               B                                    C                                   D  
       EIN of QDOT                 Total Marital Deduction              Total Charitable Deduction       Total Deductions (add cols. B and C)
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $
                               $                                $                                      $

Total .    .  .    .       . . . . . . . .  .        . .   . .   . .    . . . . . .  .    .         ▶
                                                                                                             Form 706-QDT (Rev. 6-2019)

Form 706-QDT (Rev. 6-2019)                                                                                                             Page 3
Schedule B           To be completed by trustee.

Part I   General Information (see instructions)
1a     Name of trust                                                                                      1b   EIN of trust

2a     Name of trustee                                                                                    2b   SSN or EIN of trustee

2c     Address of trustee

3       Name of designated filer, if applicable

4a     Name of surviving spouse                                                                           4b   TIN of surviving spouse

4c     Surviving spouse’s date of death (if applicable)                                                   4d   Surviving spouse’s current marital 
                                                                                                               status (or at death, if applicable)

5a     Name of decedent                                               5b   SSN of decedent                5c   Decedent’s date of death

Part II  Taxable Distributions From Prior Years
            A                                              B                               C                               D  
         Year                                           Amount                             Year                        Amount
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $
                                $                                                                       $

Total. Combine columns B and D  .                .      .  .  . . . . .    . . . . .       . .  . .  ▶

Part III Current Taxable Distributions

                                                                                                         D  
         A                                              B                          C                Amount of Hardship              E  
Date of Distribution                             Description                       Value            Exemption Claimed      Net Transfer 
                                                                                                    (see instructions)     (col. C minus col. D)

Total    .  .  .       .   . .  . . .          . .      .  .  . . . . .    . . . . .       . .  . . . . . .   .  ▶
                                                                                                                 Form 706-QDT (Rev. 6-2019)

Form 706-QDT (Rev. 6-2019)                                                                                                Page 4
Schedule B   To be completed by trustee. (continued)

Part IV Taxable Property in Trust at Death of Surviving Spouse

        A                                            B                                              C               D  
Item No.                                           Description                                  Alternate Valuation Value
                                                                                                    Date

Total   .  . . .           . . . . . .  . .    . . . .  . .    .  . . .  . . . . .            . . . .   .  ▶

Part V  Marital Deductions
        A                                                      B                                                    C  
Item No.                                  Description of Property Interests Passing to Spouse                       Value

Total   .  . . .           . . . . . .  . .    . . . .  . .    .  . . .  . . . . .            . . . .   .     ▶

Part VI Charitable Deductions

        A                            B                                C                             D               E  
Item No.                           Description          Name and Address of Beneficiary         Character of        Amount
                                                                                                  Institution

Total   .  . . .           . . . . . .  . .    . . . .  . .    .  . . .  . . . . .            . . . .   .     ▶
                                                                                                              Form 706-QDT (Rev. 6-2019)