92A200 (3-12)
Estate of:
Gifts and Transfers
Page ____ of ____
List in this schedule all gifts or transfers made within three years of the decedent’s date of death or when the decedent
retained a life interest. (Additional instructions are on reverse side.)
Was life interest retained by the decedent?
Yes
No
Item
Description of
Date of
Value at
To Whom Made
Number
Property Transferred
Transfer
Date of Death
1.
Total (including continuation page(s)) (enter on page 1, line 5) ....................................... ➤
If additional space is needed, duplicate this page and attach as a continuation page(s).