Form 8939 - Allocation Of Increase In Basis For Property Acquired From A Decedent (2010) - Department Of The Treasur Page 3

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Form 8939 (2010)
Decedent’s Social Security Number
Estate of:
Number
of
SCHEDULE A—Property Acquired by Surviving Spouse
Recipients of Schedule A: For more information and details on the information shown on this schedule, see the Instructions to Form 8939,
Publication 4895, Tax Treatment of Property Acquired from a Decedent Dying in 2010, and
Complete a separate Schedule A for the surviving spouse and for any QTIP trust. See instructions.
Part I
General Information
1a
1b
Name of executor
Executor’s address (number and street including
apartment or suite number; city, town, or post office; state; and
ZIP code) and phone number.
1c
Executor’s social security number
Phone no. (
)
2a
2b
Name of recipient
Recipient’s taxpayer identification number (TIN)
Part II
Property Information
3
For all property acquired from the decedent by the recipient named in line 2a the basis of which at the date of death is greater than its fair market
value at the date of death, provide the following information. See instructions.
(a)
(b)
(c)
(d)
(e)
Check if any gain
Accurate description
Date decedent
Adjusted
Fair market
Item No.
would be ordinary
of the property
acquired the property
basis at death
value at
(Attach statement)
(mm/dd/yyyy)
death
3a Total for columns (c) and (d)
For all property acquired from the decedent by the recipient named in line 2a the basis of which at the date of death is less than or equal to fair
4
market value at the date of death, provide the following information. See instructions.
(g)
(h)
(a)
(b)
(c)
(d)
(e)
(f)
Basis
Amount of
Accurate description
Check if qualified
Date decedent
Check if ineligible
Adjusted
Fair market
Item
increase
gain that
of the property
terminable interest
acquired
property. Attach
basis at death
value at
No.
allocated to
would be ordinary
property
the property
statement. See
death
(mm/dd/yyyy)
instructions.
property
(Attach statement)
5
Add the amounts in line 4, column (g). Enter this amount on page 1, line 19
Schedule A—Page 2

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