Form 3520 - Annual Return To Report Transactions With Foreign Trusts And Receipt Of Certain Foreign Gifts - 2017 Page 6

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Form 3520 (2017)

Page

Part IV

U.S. Recipients of Gifts or Bequests Received During the Current Tax Year From Foreign Persons

(see instructions)

During the current tax year, did you receive more than $100,000 that you treated as gifts or bequests from a nonresident

alien or a foreign estate? See instructions for special rules regarding related donors

Yes

If “Yes,” complete columns (a) through (c) with respect to each such gift or bequest in excess of $5,000. If more space is

needed, attach a statement.

(a)

(b)

(c)

Date of gift

Description of property received

FMV of property received

or bequest

Total .

▶

During the current tax year, did you receive more than $15,797 that you treated as gifts from a foreign corporation or a

foreign partnership? See instructions regarding related donors .

Yes

If “Yes,” complete columns (a) through (g) with respect to each such gift. If more space is needed, attach a statement.

(d)

(a)

(b)

(c)

Identification number,

Date of gift

Name of foreign donor

Address of foreign donor

if any

(e)

(f)

(g)

Check the box that applies to the foreign donor

Description of property received

FMV of property received

Corporation

Partnership

Do you have any reason to believe that the foreign donor, in making any gift or bequest described in lines 54 and 55,

was acting as a nominee or intermediary for any other person? If “Yes,” see instructions .

Yes

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my

Sign

knowledge and belief, it is true, correct, and complete.

Here

Signature

Title

Date

Print/Type preparer’s name

Preparer’s signature

Date

PTIN

Check

Paid