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Note: The form, instructions, or publication you are looking 
                      for begins after this coversheet.

             Please review the updated information below.

             Update to Where To File Address for Form 8971

File Form 8971 (including all Schedules(s) A) at the following address.

  Department of the Treasury 
  Internal Revenue Service 
  Stop 8307F 
  7940 Kentucky Drive 
  Florence, KY 41042-2915

 Do not use the Where To File address on the first page of the Instructions for Form 8971

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Information Regarding Beneficiaries
Form 8971 OMB No. 1545-2264
(January 2016) Acquiring Property From a Decedent
Department of the Treasury ▶ Information about Form 8971 and its separate instructions is at www.irs.gov/form8971.
Internal Revenue Service
Check box if this is a supplemental filing
Part I Decedent and Executor Information
1 Decedent's name 2 Decedent's date of death 3 Decedent's SSN

4 Executor's name (see instructions) 5 Executor's phone no. 6 Executor's TIN

7 Executor's address (number and street including apartment or suite no.; city, town, or post office; state or province; country; and
ZIP or foreign postal code)

8 If there are multiple executors, check here and attach a statement showing the names, addresses, telephone numbers, and
TINs of the additional executors.

9 If the estate elected alternate valuation, indicate the alternate valuation date:

Part II Beneficiary Information
How many beneficiaries received (or are expected to receive) property from the estate? For each beneficiary, provide
the information requested below. If more space is needed, attach a statement showing the requested information for the additional
beneficiaries.
A B C D
Name of Beneficiary TIN Address, City, State, ZIP Date Provided

Notice to Executors:
Submit Form 8971 with a copy of each completed Schedule A to the IRS. To protect privacy, Form 8971 should not be provided to any
beneficiary. Only Schedule A of Form 8971 should be provided to the beneficiary. Retain copies of all forms for the estate's records.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
Sign belief, all information reported herein is true, correct, and complete.
▲
Here
Signature of executor Date
May the IRS discuss this return with the preparer shown below? See instructions . . . . . . . . . . . . . . Yes No
Print/Type preparer’s name Preparer’s signature Date PTIN
Paid Check if
self-employed
Preparer ▶ Firm’s EIN ▶
Firm’s name
Firm’s address
Use Only ▶ Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 37794V Form 8971 (1-2016)

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Form 8971 (1-2016)

SCHEDULE A—Information Regarding Beneficiaries Acquiring Property From a Decedent
▶ Information about Form 8971 (including Schedule A) and its separate instructions is at www.irs.gov/form8971.

Check box if this is a supplemental filing

Part 1. General Information
1 Decedent's name 2 Decedent’s SSN 3 Beneficiary's name 4 Beneficiary's TIN

5 Executor's name 6 Executor's phone no.

7 Executor's address

Part 2. Information on Property Acquired
A B C D E
Item Description of property acquired from the decedent and the Schedule and item Did this Valuation Estate Tax
No. number where reported on the decedent's Form 706, United States Estate (and asset Date Value
Generation-Skipping Transfer) Tax Return. If the beneficiary acquired a partial increase (in U.S.
interest in the property, indicate the interest acquired here. estate tax dollars)
liability?
(Y/N)
Form 706, Schedule , Item

Description —

Notice to Beneficiaries:
You have received this schedule to inform you of the value of property you received from the estate of the decedent named above.
Retain this schedule for tax reporting purposes. If the property increased the estate tax liability, Internal Revenue Code section
1014(f) applies, requiring the consistent reporting of basis information. For more information on determining basis, see IRC section
1014 and/or consult a tax professional.
Page A-1

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Page of
Form 8971 (1-2016)
SCHEDULE A—Continuation Sheet
Use only if you need additional space to report property acquired (or expected to be acquired) by the beneficiary.
Check box if this is a supplemental filing

Part 1. General Information
1 Decedent's name 2 Decedent’s SSN 3 Beneficiary's name 4 Beneficiary's TIN

5 Executor's name 6 Executor's phone no.

7 Executor's address

Part 2. Information on Property Acquired
A B C D E
Item Description of property acquired from the decedent and the Schedule and item Did this Valuation Estate Tax
No. number where reported on the decedent's Form 706, United States Estate (and asset Date Value
(continue Generation-Skipping Transfer) Tax Return. If the beneficiary acquired a partial increase (in U.S.
from interest in the property, indicate the interest acquired here. estate tax dollars)
previous liability?
page) (Y/N)

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