State of Washington 
       Department of Revenue                                                Washington State 
       Audit Division - Estate Tax Section                         Estate and Transfer Tax Return
       PO Box 47474                                         For deaths occurring January 1, 2014 and after
       Olympia WA  98504-7474                                             (See separate instructions)

                    Check all that apply:            Amended return           Decedent died testate (attach copy of will)
                                                     Installment election     Federal estate tax return filed with IRS (attach copy of 706)
Part 1 - Decedent, Executor, Preparer, Confidential Release (type or complete in ink)
1. Decedent’s first name                           2. M.I.         3. Decedent’s last name                                                       4. Social Security number

5. Legal residence/domicile - city and county (or foreign country)          6. State 7. Zip code     8. Year domicile                            9. Date of birth 10. Date of death
                                                                                                     established

11. Probate or estate administration county court                                                                                                12. Cause number

13. Executor’s first name                          14. M.I.        15. Executor’s last name                                                      16. Social Security number

If multiple executors, check here    ; attach list showing names, SSNs, addresses, email addresses, and telephone numbers of additional executors.
17. Mailing address                                                18. City                                                                      19. State        20. Zip code

21 Email address                                                                                                                                 22. Telephone number

23. Preparer’s first name                          24. M.I.        25. Preparer’s last name                                                    26. Telephone number 27. Extension

28. Email address                                                  29. Company name

30. Mailing address                                                31. City                                                                      32. State        33. Zip code

34. Confidential Release and Additional Contact Methods/Staff

I,                                , on behalf of the estate of                                                                              , authorize the Department of Revenue
                  (Executor)                                                         (Decedent)
to release confidential estate tax information to                                                    . The preparer is authorized to discuss and receive 
                                                                    (Preparer)
confidential estate tax information from the Department of Revenue. In addition, I authorize the Department of Revenue to communicate the estate 
tax information through the following unsecured methods (check all that you are authorizing):      Fax           Email
I authorize the Department of Revenue to communicate with other staff from the company listed above (Item 29) by checking here: 
Part 2 - Tax Computation
1.   Total Gross Estate Less Exclusion (from Page 3, Part 5, Item 12) ...................................................                   1. 
2.   Tentative Total Allowable Deductions (from Page 3, Part 5, Item 22) ..............................................                     2. 
3.   Tentative Taxable Estate (Line 1 less Line 2) ....................................................................................     3. 
4.   Adjustments to Tentative Taxable Estate (enter an amount only if eligible for the deduction)                                            
      4a. Property Used for Farming (attach Addendum # 2) ............................. 4a.           
      4b. Qualified Family-Owned Business Interests (attach Addendum # 3) ... 4b.                     
                                                   Enter the total adjustments (add Lines 4a and 4b)  4. 
5.   Adjusted Taxable Estate (Line 3 less Line 4) ....................................................................................      5. 
6.   Washington State Applicable Exclusion Amount (see table in instructions, Page 1) .......................                               6.   
7.   Washington Taxable Estate (Line 5 less Line 6) do not enter less than “zero” .................................                         7. 
8.   Gross Washington Estate Tax (Table W in instructions) compute tax using the amount on Line 7 ........                                  8. 
9.   Apportionment for Out of State Property: (enter an amount only if eligible for apportionment)
      Apportioned Washington Estate Tax Due (attach Addendum # 4) ..............................................                            9. 
10.  Washington Estate Tax Due (equals Line 8 or, if apportioning for out of state property, Line 9) ..............                         10. 
11.  Tax Previously Paid to Washington State ....................................................................................           11. 
12.  Balance (     amount owing or      refund due) ....................................................................................... 12. 
13.  Interest (due on any tax not paid within nine months after date of death or payable on a refund) .................                     13. 
14.  Total Tax and Interest (add Lines 12 and 13) ....................................................................................      14. 
Under penalty of law, I declare that I have examined this return and, to the best of my knowledge and belief, it is true, correct, and complete. 
In addition, by signing below, I am authorizing the confidential release section (Part 1, Item 34) above.

____________________________________________________________________                                                                         ________________________________
                          (Signature of executor)                                                                                                          (Date)
REV 85 0050 (4/7/22)                                                        Reset This Form          Print This Form                                                 Page 1

Estate of:                                                                                      Decedent’s Social Security Number

Part 3 - Elections by the Executor
Check “Yes” or “No” for each question (see instructions)
Note: Some of these elections may require the posting of bonds or liens.                                                                                                                  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.
3. Do you elect to pay the taxes in installments as described in Internal Revenue Code (IRC) §6166? ....................................
  If “Yes,” you must attach the additional information described in the instructions.
4. Do you elect to postpone the part of the taxes attributable to a reversionary or remainder interest as described in  
  IRC §6163? .............................................................................................................................................................................
Part 4 - General Information
Note: Attach the necessary supplemental documents. You must attach the death certificate. (See instructions)
1. Marital status of the decedent at the time of death (attach a list of all prior marriages that ended due to annulment, divorce or death):
       Married
       Widow or widower - Name, SSN, and date of death of deceased spouse: _______________________________________________
       Single
       Legally separated
       Divorced - Date divorce became final: ______________________________________________________________
2. Surviving spouse’s name                                      3. Social Security number               4. Amount received (see instructions)

5. Individuals (other than the surviving spouse), trusts, or other estates who receive benefits from the estate (do not include charitable 
  beneficiaries shown in Schedule O) (See instructions). Attach additional sheet, if necessary.
  Name of individual, trust, or estate receiving $5,000 or more Identifying number              Relationship to                                                                   Amount (see 
                                                                                                decedent                                                                          instructions)

  All unascertainable beneficiaries and those who receive less than $5,000 ..............................................................
  Total ..........................................................................................................................................................................
Check “Yes” or “No” for each question. If “Yes,” you must attach additional information.                                                                                                  Yes  No
6. Does the gross estate contain any Washington or federal qualified terminable interest property (QTIP) from a prior gift or 
  estate (RCW 83.100.047 and/or IRC §2044)? (See instructions) ...........................................................................................
7a. Have federal gift tax returns ever been filed?  .......................................................................................................................
   If  “Yes,” attach copies of the returns, if available, and furnish the following information.
7b. Period(s) covered                                           7c. Internal Revenue Office(s) where filed

8a. Was there any insurance on the decedent’s life that is not included on the return as part as the gross estate?  .................
8b. Did the decedent own any insurance on the life of another that is not included in the gross estate?  ..................................
9.   Did the decedent at the time of death own any property as a joint tenant with the right of survivorship in which (a) one 
   or more of the other joint tenants were someone other than the decedent’s spouse and (b) less than the full value of            
   the property is included on the return as part of the gross estate?  If “Yes,” you must complete and attach Schedule E ....
10a. Did the decedent, at the time of death, own any interest in a partnership (for example, a family limited partnership), an 
   unincorporated business, or a limited liability company; own a fractional interest in real estate; or own any stock in an            
   inactive or closely held corporation? ...................................................................................................................................
10b. If “Yes,” was the value of any interest owned (from above) discounted on this estate tax return? .....................................
   If “Yes,” see instructions for Schedule F for reporting the total accumulated or effective discounts taken on a Schedule 
   A, F, or G.
11.   Did the decedent make any transfer described in IRC §2035, §2036, §2037, or §2038? (See instructions) ......................
   If “Yes,” you must complete and attach Schedule G.
12a. Were there in existence at the time of the decedent’s death any trusts created by the decedent during his or her  
   lifetime?  If “Yes,” attach a copy or copies of trust(s). ..........................................................................................................

REV 85 0050 (4/7/22)                                                                                                                                                                          Page 2

Check “Yes” or “No” for each question. If “Yes,” you must attach additional information.                                                                                           Yes No
12b. Were there in existence at the time of the decedent’s death any trusts not created by the decedent under which the 
   decedent possessed any power, beneficial interest, or trusteeship? ........................................................................................
12c. Was the decedent receiving income from a trust created after October 22, 1986 by a parent or grandparent? .......................
   If “Yes,” was there GST taxable termination (under IRC §2612) upon the death of the decedent? ..........................................
12d. If there was a GST taxable termination (under IRC §2612), attach a statement to explain. Provide a copy of the trust or 
   will creating the trust, and give the name, address, and phone number of the current trustee(s). Documents attached? ........
13.  Did the decedent ever possess, exercise, or release any general power of appointment? .......................................................
   If “Yes,” you must complete and attach Schedule H.
14.  Did the decedent have an interest in or a signature or other authority over a financial account in a foreign country, such as a 
   bank account, securities account, or other financial account?...................................................................................................
15.   Was the decedent, immediately before death, receiving an annuity described in the “General” paragraph of the instructions 
   for Schedule I or a private annuity? ...........................................................................................................................................
   If “Yes,” you must complete and attach Schedule I.
16.   Was the decedent ever the beneficiary of a trust for which a deduction was claimed by the estate of a pre-deceased 
   spouse consistent with RCW 83.100.047 and/or IRC §2056(b)(7) and which is not reported on this return? ..........................
   If “Yes,” attach an explanation.
17.   Was a qualified disclaimer filed as a part of the administration of the estate? If “Yes,” you must submit a copy of the    
        disclaimer.
Part 5 - Recapitulation
Item 
                                   Gross Estate                                          Alternate Value                                Value at Date of Death
Number
   1  Schedule A - Real Estate  ............................................ 1.
   2  Schedule B - Stocks and Bonds  ................................. 2.
   3  Schedule C - Mortgages, Notes, and Cash  ................ 3.
   4  Schedule D - Insurance on the Decedent’s Life  ......... 4.
   5  Schedule E - Jointly Owned Property  ......................... 5.
   6  Schedule F - Other Miscellaneous Property  ............... 6.
      (May need to attach Addendum # 1)
   7  Schedule G - Transfers During Decedent’s Life  ......... 7.
   8  Schedule H - Powers of Appointment  ......................... 8.
   9  Schedule I - Annuities  ................................................. 9.
  10  Total Gross Estate (add Items 1 through 9) ............10.
  11  Schedule U - Qualified Conservation Easement 
      Exclusion  .................................................................... 11.
  12  Total Gross Estate less Exclusion 
      (subtract Item 11 from Item 10)
      Enter here and on Line 1 of Part 2 - Tax Computation...... 12.
Item 
                                                Deductions                                                                              Amount
Number
  13  Schedule J - Funeral Expenses and Expenses Incurred in Administrating Property 
      Subject to Claims .......................................................................................................... 13.
  14  Schedule K - Debts of the Decedent  ............................................................................ 14.
  15  Schedule K - Mortgages and Liens  .............................................................................. 15.
  16  Total of Items 13 through 15 .......................................................................................... 16.
  17  Allowable Amount of Deductions from Item 16 (see the instructions for Item 17 of the 
      Recapitulation)............................................................................................................... 17.
  18  Schedule L - Net Losses During Administration ............................................................ 18.
  19  Schedule L - Expenses Incurred in Administering Property Not Subject to Claims .......... 19.
  20  Schedule M - Bequests, Etc., to Surviving Spouse (may need to attach Addendum # 1) ...... 20.
  21  Schedule O - Charitable, Public, and Similar Gifts and Bequests ............................................ 21.
      Tentative Total Allowable Deductions (add Items 17 through 21).
  22  Enter here and on Line 2 of Part 2 - Tax Computation ............................................. 22.

REV 85 0050 (4/7/22)                                                                                                                                                               Page 3

Estate of:                                                                               Decedent’s Social Security Number

                                 Schedule A - Real Estate
       • For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.
       • Real estate that is part of a sole proprietorship should be shown on Schedule F.
       • Real estate that is included in the gross estate under IRC §2035, §2036, §2037, or §2038 should be shown on Schedule G.
       • Real estate that is included in the gross estate under IRC §2041 should be shown on Schedule H.
       • If you elect IRC §2032A valuation, you must complete Schedule A and Schedule A-1. 
Item                                                                                     Alternate                                               Value at Date of
                     Description                                                                                                  Alternate Value
Number                                                                            Valuation Date                                                 Death
1.

Total from continuation schedules (or additional sheets) attached to this schedule .......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 1.) ................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)
REV 85 0050 (4/7/22)                                                                                                              Schedule A -   Page 4

Estate of:                                                                                   Decedent’s Social Security Number

                     Schedule B - Stocks and Bonds
                     (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)
           Description, including face amount of bonds or number of 
Item                                                                                         Alternate                                            Value at Date of
           shares and par value for identification. Give CUSIP number.            Unit Value                                       Alternate Value
Number                                                                                       Valuation Date                                       Death
           If trust, partnership, or closely held entity, give FEIN.
                     CUSIP number 
                     or FEIN, where 
                     applicable
1.

Total from continuation schedules (or additional sheets) attached to this schedule ........................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 2.) .................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)
REV 85 0050 (4/7/22)                                                                                                               Schedule B - Page 5

Estate of:                                                                        Decedent’s Social Security Number

                     SCHEDULE C - Mortgages, Notes, and Cash
           (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)
Item                                                                              Alternate                                                      Value at Date of
                     Description                                                                                                  Alternate Value
Number                                                                            Valuation Date                                                 Death
1.

Total from continuation schedules (or additional sheets) attached to this schedule .......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 3.) ................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                                              Schedule C - Page 6

Estate of:                                                                        Decedent’s Social Security Number

                     SCHEDULE D - Insurance on the Decedent’s Life
                     You must list all policies on the life of the decedent and attach a Federal Form 712 for each policy.
Item                                                                              Alternate                                                      Value at Date of
                     Description                                                                                                  Alternate Value
Number                                                                            Valuation Date                                                 Death
1.

Total from continuation schedules (or additional sheets) attached to this schedule .......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 4.) ................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                                              Schedule D - Page 7

Estate of:                                                                        Decedent’s Social Security Number

                                      Schedule E - Jointly Owned Property
                     (If you elect IRC §2032A valuation, you must complete Schedule E and Schedule A-1.)
Part 1. Qualified Joint Interests - Interests Held by the Decedent and His or Her Spouse as the Only Joint Tenants (IRC §2040(b)(2))
Item           Description. For securities, give CUSIP number. If trust,          Alternate                                                                                      Value at Date of
                                                                                                                                                                  Alternate Value
Number               partnership, or closely held entity, give FEIN.              Valuation Date                                                                                 Death
                                                          CUSIP number 
                                                          or FEIN, where 
                                                          applicable
  1.

Total from continuation schedules (or additional sheets) attached to this schedule ......................................
1a. Totals ..................................................................................................................................................1a.
1b. Amounts included in gross estate (one-half of Line 1a)......................................................................1b.
Part 2. All Other Joint Interests
2a. State the name and address of each surviving co-tenant. If there are more than three surviving co-tenants, list the additional co-tenants on 
  an attached sheet.
                                 Name                                             Address (number and street, city, state, and zip code)
A.
B.
C.
       Enter Letter  Description (including alternate valuation date, if any).                                                                                                   Includible 
Item                                                                              Percentage                                                                      Includible
           for                   For securities, give CUSIP number.                                                                                                              Value at Date of
Number                                                                            Includible                                                                      Alternate Value
       Co-tenant     If trust, partnership, or closely held entity, give FEIN.                                                                                                   Death
                                                          CUSIP number 
                                                          or FEIN, where 
                                                          applicable
  1.

Total from continuation schedules (or additional sheets) attached to this schedule ......................................
2b. Total other joint interests ....................................................................................................................2b.
TOTAL includible joint interests (add Lines 1b and 2b) (Also enter on Part 5 - Recapitulation, Page 3, 
at Item 5.) ......................................................................................................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)
REV 85 0050 (4/7/22)                                                                                                                                              Schedule E - Page 8

Estate of:                                                                           Decedent’s Social Security Number

           Schedule F - Other Miscellaneous Property Not Reportable Under Any Other Schedule
           (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)
                     (If you elect IRC §2032A valuation, you must complete Schedule F and Schedule A-1.)
           (If the estate contains property pursuant to RCW 83.100.047 (§2044 property), Addendum # 1 must be attached.)
1. Did the decedent at the time of death own any works of art, items, or any collection whose artistic or collectible value                                                        Yes  No
exceeded $3,000? ..................................................................................................................................................................
If “Yes,” submit full details on this schedule and attach appraisals.
2. Has the decedent’s estate, spouse, or any other person, received (or will receive) any bonus or award as a result of the 
decedent’s employment or death? .........................................................................................................................................
If “Yes,” submit full details on this schedule.
3. Did the decedent at the time of death have, or have access to, a safe deposit box? ............................................................
If “Yes,” state location, and if held in joint names of the decedent and another, state name and relationship of joint 
depositor. 
If any of the contents of the safe deposit box are omitted from the schedules in this return, explain fully why omitted.

Item                 Description. For securities, give CUSIP number.                 Alternate                                                                                     Value at Date of
                                                                                                                                 Alternate Value
Number               If trust, partnership, or closely held entity, give FEIN.       Valuation Date                                                                                Death
                                                                     CUSIP number 
                                                                     or FEIN, where 
                                                                     applicable
1.

Total from continuation schedules (or additional sheets) attached to this schedule ......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 6.) ...............................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)
REV 85 0050 (4/7/22)                                                                                                             Schedule F - Page 9

Estate of:                                                                                                                 Decedent’s Social Security Number

                     SCHEDULE G - Transfers During Decedent’s Life
                     (If you elect IRC §2032A valuation, you must complete Schedule G and Schedule A-1.)
Item       Description. For securities, give CUSIP number. If trust, partnership,                                          Alternate                     Value at Date of
                                                                                                                                          Alternate Value
Number               or closely held entity, give FEIN.                                                                    Valuation Date                Death
A.     Gift tax paid or payable by the decedent or the estate for all gifts made by the 
       decedent or his or her spouse within three years before the decedent’s death 
       (IRC §2035(b))..................................................................................................... XXXXX
B.     Transfers includible under IRC §2035(a), §2036, §2037, or §2038:
1.

Total from continuation schedules (or additional sheets) attached to this schedule .......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 7.) ................................................................
                     SCHEDULE H - Powers of Appointment
                     (Include “5 and 5 lapsing” powers (IRC §2041(b)(2)) held by the decedent.)
                     (If you elect IRC §2032A valuation, you must complete Schedule H and Schedule A-1.)
Item                                                                                                                       Alternate                     Value at Date of
                     Description                                                                                                          Alternate Value
Number                                                                                                                     Valuation Date                Death
1.

Total from continuation schedules (or additional sheets) attached to this schedule .......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 8.) ................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                                                      Schedules G and H - Page 10

Estate of:                                                                        Decedent’s Social Security Number

                                 Schedule I - Annuities
Note: Generally, no exclusion is allowed for the estates of decedents dying after December 31, 1984 (see instructions).
A. Are you excluding from the decedent’s gross estate the value of a lump-sum distribution  described in IRC §2039(f)(2)                               Yes  No
(as in effect before its repeal by the Federal Deficit Reduction Act of 1984)? ........................................................................
If “Yes,” you must attach the information required by the instructions.
                                                                                                                                                       Includible
Item                 Description                                                  Alternate                                      Includible
                                                                                                                                                       Value at Date of
Number     Show the entire value of the annuity before any exclusions             Valuation Date                                 Alternate Value
                                                                                                                                                       Death
1.

Total from continuation schedules (or additional sheets) attached to this schedule ......................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 9.) ...............................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)
REV 85 0050 (4/7/22)                                                                                                             Schedule I -              Page 11

Estate of:                                                                                                               Decedent’s Social Security Number

       Schedule J - Funeral Expenses and Expenses Incurred in Administering Property Subject to Claims
Note:  Do not list on this schedule expenses of administering property not subject to claims. For those expenses, see the instructions for 
       Schedule L. 
       If executors’ commissions, attorney fees, etc., are claimed and allowed as a deduction for estate tax purposes, they are not allowable 
       as a deduction in computing the taxable income of the estate for the federal income tax purposes.
Item 
                                 Description                                                                             Expense Amount                          Total Amount
Number
       A. Funeral expenses
1.

       Total funeral expenses (less one-half in a community property estate)........................................................
       B. Administration expenses
       1. Executors’ commissions - amount       estimated,         agreed upon, or         paid
       2. Attorney fees - amount       estimated,         agreed upon, or         paid
       3. Accountant fees - amount       estimated,         agreed upon, or         paid
       4. Miscellaneous expenses                                                                                         Expense Amount
1.

Total miscellaneous expenses from continuation schedules (or additional sheets) 
attached to this schedule ...............................................................................................
Total miscellaneous expenses ....................................................................................................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 13.) ..........................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                                                                             Schedule J - Page 12

Estate of:                                                                        Decedent’s Social Security Number

                     Schedule K - Debts of the Decedent, and Mortgages and Liens

Item                                                                              Amount Unpaid to Amount in                                                 Amount Claimed 
                     Debts of the Decedent - Creditor and Nature of Claim
Number                                                                            Date             Contest                                                   as a Deduction
1.

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 14.) ..........................................................................................
Item 
                     Mortgages and Liens - Description                                                                                                       Amount
Number
1.

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 15.) ..........................................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                               Schedule K - Page 13

Estate of:                                                                        Decedent’s Social Security Number

                     Schedule L - Net Losses During Administration and Expenses Incurred
                             in Administering Property Not Subject to Claims
Item                        Net Losses During Administration
                                                                                                                                                             Amount
Number               (Note:  Do not deduct losses claimed on a federal income tax return.)
1.

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 18.) ..........................................................................................
Item                  Expenses Incurred in Administering Property Not Subject to Claims
                                                                                                                                                             Amount
Number                      (Indicate whether estimated, agreed upon, or paid.)
1.

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 19.) ..........................................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                      Schedule L -                                                       Page 14

Estate of:                                                                             Decedent’s Social Security Number

                                      SCHEDULE M - Bequests, etc., to Surviving Spouse
                                                                                                                                                                            Yes No
1. Did any property pass to the surviving spouse as a result of a qualified disclaimer? ....................................................... 
   If “Yes,” attach a copy of the written disclaimer required by IRC §2518(b).
2. a.  In what country was the surviving spouse born? __________________________________________
   b. What is the surviving spouse’s date of birth?   ____________________________________________
   c.  Is the surviving spouse a U.S. citizen? ......................................................................................................................... 
   d. If the surviving spouse is a naturalized citizen,
     when did the surviving spouse acquire citizenship? ________________________________________
   e. If the surviving spouse is not a U.S. citizen,
     of what country is the surviving spouse a citizen? _________________________________________
3. Election Out of QTIP Treatment of Annuities. Do you elect under IRC §2056(b)(7)(C)(ii) not to treat as QTIP any
   joint and survivor annuities that are included in the gross estate and would otherwise be treated as QTIP under IRC
   §2056(b)(7)(C)?  (See instructions) .................................................................................................................................... 

Item                      Description of Property Interests Passing to Surviving Spouse.                                                                                    Amount
Number               For securities, give CUSIP number. If trust, partnership, or closely held entity, give FEIN.
       QTIP / QDOT property (must attach Addendum # 1):
A1

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
       All other property:
B1

Total from continuation schedules (or additional sheets) attached to this schedule ...................................................................
Total amount of property interests listed on Schedule M
(Also enter on Part 5 - Recapitulation, Page 3, at Item 20.) .......................................................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                             Schedule M - Page 15

Estate of:                                                                               Decedent’s Social Security Number

                     SCHEDULE O - Charitable, Public, and Similar Gifts and Bequests
                                                                                                                                                         Yes   No
1a.  If the transfer was made by will, has any action been instituted to have interpreted or to contest the will or any of its 
   provisions affecting the charitable deductions claimed in this schedule? ............................................................................
   If “Yes,” full details must be submitted with this schedule.
1b.  According to the information and belief of the executor, is any such action planned? ........................................................
   If “Yes,” full details must be submitted with the schedule.
2. Did any property pass to a charity as the result of a qualified disclaimer? ..........................................................................
   If “Yes,” attach a copy of the written declaimer required by IRC §2518(b).

   Item              Name and Address of Beneficiary                                     Character of Institution                                        Amount
Number
   1.

Total from continuation schedules (or additional sheets) attached to this schedule ........................................................
TOTAL (Also enter on Part 5 - Recapitulation, Page 3, at Item 21) ................................................................................
(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size and format.)

REV 85 0050 (4/7/22)                                                                                                                              Schedule O - Page 16

Estate of:                                                                                   Decedent’s Social Security Number

                                                 Schedule A-1 - IRC §2032A Valuation
Part 1. Type of Election (Before making an election, see the checklist in the instructions): 
 Protective election (IRC Regulations §20.2032A-8(b)). Complete Part 2, Line 1, and Column A of Lines 3 and 4. (See instructions) 
 Regular election. Complete all of Part 2 (including Line 11, if applicable.) (See instructions) 
Before completing Schedule A-1, see the checklist in the instructions for the information and the documents that must be included to make a 
valid election.
Part 2. Notice of Election (IRC Regulations §20.2032A-8(a)(3))
       Note:  All real property entered on Lines 2 and 3 must also be entered on Schedules A, E, F, G, or H, as applicable.
1. Qualified use - check one  Farm used for farming, or 
                              Trade or business other than farming
2. Real property used in a qualified use, passing to qualified heirs, and to be specially valued on this return.
                                                 B                            C                                            D
               A                                 Full Value                   Adjusted Value                    Value Based on Qualified Use 
Schedule / Item Number from                      (without IRC §2032A(b)(3)(B) (with IRC §2032A(b)(3)(B)         (without IRC §2032A(b)(3)(B) 
            Return                               adjustment)                  adjustment)                       adjustment)

Totals: .........................................
Attach a legal description of all property listed on Line 2.
Attach copies of appraisals showing the Column B values for all property listed on Line 2.
3. Real property used in a qualified use, passing to qualified heirs, but not specially valued on this return.

                                                 B                            C                                            D
               A                                 Full Value                   Adjusted Value                    Value Based on Qualified Use 
Schedule / Item Number from                      (without IRC §2032A(b)(3)(B) (with IRC §2032A(b)(3)(B)         (without IRC §2032A(b)(3)(B) 
            Return                               adjustment)                  adjustment)                       adjustment)

Totals: .........................................
If you checked “Regular election,” you must attach copies of appraisals showing the Column B values for all property listed on Line 3.

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4. Personal property used in a qualified use and passing to qualified heirs.
                                                 B                                                                                                   B
          A                                      Adjusted Value             A                                             Adjusted Value
                                                                           Schedule / Item Number from            (with IRC §2032A(b)(3)(B)
 Schedule / Item Number from                     (with IRC §2032A(b)(3)(B)  Return                                        adjustment)
         Return                                  adjustment)
                                                                           “Subtotal” from Col. B, below left     ........

Subtotal: ......................................                           Total adjusted value ..................
5. Enter the value of the total gross estate as adjusted under IRC §2032A(b)(3)(A) _________________________________
6. Attach a description of the method used to determine the special value based on qualified use.
7. Did the decedent and/or a member of his or her family own all property listed on Line 2 for at least five of the eight years
 immediately preceding the date of the decedent’s death? ..........................................................................                    Yes         No
8. Were there any periods during the eight-year period preceding the date of the decedent’s death during which the decedent
 or a member of his or her family:
 a.  Did not own the property listed on Line 2? .............................................................................................          Yes         No
 b.  Did not use the property listed on Line 2 in a qualified use?...................................................................                  Yes         No
 c. Did not materially participate in the operation of the farm or other business within the meaning of
 IRC §2032A(e)(6)? .................................................................................................................................   Yes         No
 If “Yes,” to any of the above, you must attach a statement listing the periods. If applicable, describe whether the exceptions 
 of IRC §2032A(b)(4) or (5) are met.
9. Attach affidavits describing the activities constituting material participation and the identity and relationship to the
 decedent of the material participants.
10. Persons holding interests. Enter the requested information for each party who received any interest in the specially valued
 property.
                       Name                                                                         Address
A
B
C
D
E
F
G
H
                     Identifying Number                                    Relationship to Decedent Fair Market Value                                Special-Use Value
A
B
C
D
E
F
G
H
11. Woodlands election Check here     if you wish to make a Woodlands election as described in IRC §2032A(e)(13). Enter the schedule
 and item numbers from this return of the property for which you are making this election  ____________________________________ .
 You must attach a statement explaining why you are entitled to make this election. The Department may require more information to
 substantiate this election. You will be notified by the Department if you must supply further information.
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Estate of:                                                                           Decedent’s Social Security Number

                                 SCHEDULE U - Qualified Conservation Easement Exclusion
Part 1 - Election

Note:  The executor is deemed to have made the election under IRC §2031(c)(6) if he or she files Schedule U and excludes any qualifying 
       conservation easements from the gross estate.

Part 2 - General Qualifications

1. Describe the land subject to the qualified conservation easement (see instructions.)  ______________________________

 _________________________________________________________________________________________________

2. Did the decedent or a member of the decedent’s family own the land described above during the
three-year period ending on the date of the decedent’s death?  ...........................................................       Yes            No

3. Describe the conservation easement with regard to which the exclusion is being claimed (see instructions).

 _________________________________________________________________________________________________

Part 3 - Computation of Exclusion

4.   Estate tax value of the land subject to the qualified conservation easement (see instructions)  ....4.

5. Date of death value of any easements granted prior to decedent’s death and included on line 10
below (see instructions)  .................................................................................................................5.

6.   Add lines 4 and 5  ...........................................................................................................................6.

7.   Value of retained development rights on the land (see instructions) ..............................................7.

8.   Subtract line 7 from line 6 ...............................................................................................................8.

9.   Multiply line 8 by 30% (.30) ............................................................................................................9.
10. Value of qualified conservation easement for which the exclusion is being claimed
(see instructions) ............................................................................................................................10. 
Note:  If line 10 is less than line 9, continue with line 11. If line 10 is equal to or more than line 9, 
skip lines 11 through 13, enter “.40” on line 14, and complete the schedule.
11. Divide line 10 by line 8. Figure to 3 decimal places (for example, “.123”) ......................................11. 
Note:  If line 11 is equal to or less than .100, stop here; the estate does not qualify for the 
conservation easement exclusion.

12. Subtract line 11 from .300. Enter the answer in hundredths by rounding any thousandths up to the
next higher hundredth (that is, .030 = .03; but .031 = .04) .............................................................12.

13. Multiply line 12 by 2 ........................................................................................................................13.

14. Subtract line 13 from .40 ................................................................................................................14.

15. Deduction under IRC §2055(f) for the conservation easement (see instructions) ..........................15.

16. Amount of indebtedness on the land (see instructions) ..................................................................16.

17. Total reductions in value (add lines 7, 15, and 16) .........................................................................17.

18. Net value of land (subtract line 17 from line 4) ...............................................................................18.

19. Multiply line 18 by line 14 ...............................................................................................................19.

20. Enter the smaller of line 19 or the exclusion limitation (see instructions).
(Also enter on Part 5 - Recapitulation, Page 3, at Item 11.) ...........................................................20.
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Estate of:                                                                          Decedent’s Social Security Number

                                       CONTINUATION SCHEDULE
                     Continuation of Schedule  ____________________________________
                                       (Enter letter of schedule you are continuing.) 
                                                                                                                                                             Value at Date  
                     Description.                                    Unit Value 
Item                                                                                Alternate                                                                of Death 
                     For securities, give CUSIP number.              (Sch. B, E, or                                                           Alternate Value
Number                                                                              Valuation Date                                                           or Amount 
           If trust, partnership, or closely held entity, give FEIN. G only)
                                                                                                                                                             Deductible

TOTAL (Carry forward to main schedule.).......................................................................................................
                     (In case you will need more than one, make copies of this continuation schedule before completing it.)

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