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Form Rev 85 0046 - Schedule T - Qualified Family-Owned Business Interest Deduction - Washington Department Of Revenue Page 4

Part 5  Agreement to Family-Owned Business Interest Deduction Under Section 2057 (Cont’d)

Date of Death

Estate of:

Decedent’s Social Security Number

•

Other acts (specify)

By signing this agreement, the agent agrees to provide the Department of Revenue with any requested information

concerning the qualified business interests and to notify the Department of Revenue of any disposition or disqualifying

events with regard to said interests.

Name of Agent

Signature

Address

The interests to which this agreement relates is listed in Form 85 0046, Washington Estate (and Generation-Skipping

Transfer) Tax Return, along with their fair market value according to section 2031 (or, if applicable, section 2032A) of the

Code. The name, address, social security number, and interest (including the value) of each of the undersigned in this

business(es) are as set forth in the attached Schedule T.

IN WITNESS WHEREOF, the undersigned have hereunto set their hands at

this

day of

SIGNATURES OF EACH OF THE QUALIFIED HEIRS:

Signature of qualified heir

Signatures of other interested parties

Schedule T, Part 5

REV 85 0046 (6-03-03)

Page 35

Form Rev 85 0046 - Schedule T - Qualified Family-Owned Business Interest Deduction - Washington Department Of Revenue Page 4