Form 706 - United States Estate (And Generation-Skipping Transfer) Tax Return Page 2

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Form 706 (Rev. 11-01)

Estate of:

Part 3—Elections by the Executor

Yes

Please check the “Yes” or “No” box for each question. (See instructions beginning on page 5.)

Do you elect alternate valuation?

Do you elect special use valuation?

If “Yes,” you must complete and attach Schedule A–1.

Do you elect to pay the taxes in installments as described in section 6166?

If “Yes,” you must attach the additional information described on page 8 of the instructions.

Do you elect to postpone the part of the taxes attributable to a reversionary or remainder interest as described in

section 6163?

Part 4—General Information

(Note: Please attach the necessary supplemental documents. You must attach the death certificate.)

(See instructions on page 9.)

Authorization to receive confidential tax information under Regs. sec. 601.504(b)(2)(i); to act as the estate’s representative before the IRS; and to make

written or oral presentations on behalf of the estate if return prepared by an attorney, accountant, or enrolled agent for the executor:

Name of representative (print or type)

State

Address (number, street, and room or suite no., city, state, and ZIP code)

I declare that I am the

attorney/

certified public accountant/

enrolled agent (you must check the applicable box) for the executor and prepared

this return for the executor. I am not under suspension or disbarment from practice before the Internal Revenue Service and am qualified to practice in

the state shown above.

Signature

CAF number

Date

Telephone number

Death certificate number and issuing authority (attach a copy of the death certificate to this return).

Decedent’s business or occupation. If retired, check here

and state decedent’s former business or occupation.

Marital status of the decedent at time of death:

Married

Widow or widower—Name, SSN, and date of death of deceased spouse

Single