Form M706q - Election To Claim The Qualified Small 2012 M706q Business And Farm Property Deduction - 2012 Page 3

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2012 M706Q P3

Election to Claim the Qualified Small Business and Farm Property Deduction 2012 (continued)

Decedent’s first name, middle initial, last name

Decedent’s Social Security number

Executor’s first name, middle initial, last name

Executor’s Social Security number

Part 4 — Agreement (Must be completed and signed by each and every qualified heir and the executor)

Heirs: All persons signing below agree and attest to the following:

I am a “family member” as provided by M.S. 291.03, subd. 8.

I am a “qualified heir” as provided by M.S. 291.03, subd. 8(c).

Each and every qualified heir who acquired the qualified property or an interest in the qualified property described on Line 1, Parts 5

and 6 is listed below.

If any qualified heir or family member disposes of any interest in the qualified property described on Line 1, Parts 5 and 6, other

than by a disposition to a family member, during the three-year period following decedent’s death, I am personally responsible for

filing and paying the recapture tax equal to the amount listed on Line 4, Part 7, multiplied by 16%. The filing and payment due date

is no later than six months from the date of the disqualifying disposition.

If a family member ceases to use the qualified property described on Line 1, Parts 5 and 6 in the operation of the trade or busi-

ness described on Line 12, Part 3 during the three-year period following decedent’s death, I am personally responsible for filing and

paying the recapture tax equal to the amount listed on Line 4, Part 7, multiplied by 16%. The filing and payment due date is no later

than six months from the date of the disqualifying cessation of the trade or business.

This schedule is correct and complete to the best of my knowledge and belief.

Name

Address

City

State

Zip code

Signature of qualified heir

Date

Social Security number

Phone number

Name

Address

City

State

Zip code

Signature of qualified heir

Date

Social Security number

Phone number

Name

Address

City

State

Zip code

Signature of qualified heir

Date

Social Security number

Phone number

Name

Address

City

State

Zip code

Signature of qualified heir

Date

Social Security number

Phone number

Name

Address

City

State

Zip code

Signature of qualified heir

Date

Social Security number

Phone number

Executor: I agree and attest to the following:

I am the executor of the decedent’s estate.

Each and every qualified heir who acquired the qualified property or an interest in the qualified property described on Line 1, Parts 5

and 6 signed the agreement above.