Form 8939
Department of the Treasury
Internal Revenue Service
Allocation of Increase in Basis for Property
Acquired From a Decedent
File separately. Do NOT file with Form 1040. See below for filing address.
To be filed for decedents dying after December 31, 2009, and before January 1, 2011.
OMB No. 1545-2203
2010
If this is an amended Form 8939, check here
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If filing this Form 8939 revokes a timely and otherwise valid section 1022 election, check here
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Part 1—Decedent and Executor
1a
Decedent’s first (given) name and middle initial (and maiden name, if any)
1b Decedent’s last (family) name 2 Decedent’s Social Security No.
3 County, state, and ZIP code, or foreign country, of legal residence
(domicile) at time of death
4 Check if decedent was a nonresident
and was not a citizen of the U.S. See
instructions. If checked, enter nationality
(citizenship)
5 Date of death
6a Name of executor (see instructions)
6b Executor’s address (number and street including apartment or suite number; city,
town, or post office; state; and ZIP code) and phone number
Phone no. (
)
6 c Executor’s social security number (see instructions)
Part 2—Basis Allocation Computation
7 Marital status of the decedent at time of death:
Married
Widow or widower—
Name, SSN, and date of death of deceased spouse
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Single
Legally separated
Divorced—
Date divorce decree became final
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8a Surviving spouse’s name 8b
Spouse's social security number
9 Individuals (other than the surviving spouse), trusts, estates, or other entities who acquired property from the estate (see instructions).
Name of individual, trust, estate, or other entity Taxpayer identification number
10 Built-in loss (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Capital loss carryforward (see instructions) . . . . . . . . . . . . . . . . . . . . 11
12 Net operating loss carryforward (see instructions) . . . . . . . . . . . . . . . . . . 12
12 a Add lines 10, 11, and 12 (see instructions) . . . . . . . . . . . . . . . . . . . . 12a
12 b Enter $1,300,000 or $60,000 (see instructions) . . . . . . . . . . . . . . . . . . . 12b
12 c General Basis Increase. Add the amounts on line 12a and line 12b (see instructions) . . . . . . . . 12c
13
Enter the total amount of General Basis Increase allocated on all Schedules A line 4B, column (e)(i) (see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
14
Enter the total amount of Spousal Property Basis Increase allocated on all Schedules A line 4B, column (e)(ii)
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. I (executor) understand that if any other person files a Form 8939 or Form 706 (or Form 706-NA) with respect to this decedent or estate, that my
name and address will be shared with such person, and I (executor) also hereby request the IRS share with me the name and address of any person who files a Form 8939
or Form 706 (or Form 706-NA) with respect to this decedent or estate. Declaration of preparer other than the executor is based on all information of which preparer has any
knowledge.
Sign
Here
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Signature of executor
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Date
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Signature of executor
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Date
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
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Firm’s EIN
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Firm’s address
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Phone no.
Send Form 8939 (including accompanying schedules and statements) to: Internal Revenue Service, Estate & Gift Stop 824G, 201 W. Rivercenter Blvd.,
Covington, KY 41011
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions for this form. Cat. No. 37755W
Form 8939 (2010)