Form 706-NA (Rev. 6-2019)
Page 2
Part III General Information
Authorization to receive confidential tax information under Regulations section 601.504(b)(2), to act as the estate’s representative before
the IRS, and/or to make written or oral presentations on behalf of the estate:
Name of representative (print or type) License state
Address (city or town, state or province, country, and ZIP or foreign postal code)
I declare that I am the attorney/ certified public accountant/ enrolled agent/ other representative
(check the applicable
box) for the executor. If licensed to practice in the United States, I am not under suspension or disbarment from practice before the Internal
Revenue Service and am qualified to practice in the state shown above.
If not licensed to practice in the United States, check here.
Signature CAF number Date Telephone number
Yes No
1a Did the decedent die testate? . . . . .
b Were letters testamentary or of administration
granted for the estate? . . . . . . .
If granted to persons other than those filing the
return, include names and addresses on page 1.
2
Did the decedent, at the time of death, own any:
a
Real property located in the United States? .
b U.S. corporate stock? . . . . . . . .
c
Debt obligations of (1) a U.S. person; or (2) the
United States, a state or any political
subdivision, or the District of Columbia? .
d
Other property located in the United States? .
3 Was the decedent engaged in business in the
United States at the date of death? . . .
4
At the date of death, did the decedent have
access, personally or through an agent, to a
safe deposit box located in the United States?
5
At the date of death, did the decedent own
any property located in the United States as a
joint tenant with right of survivorship; as a
tenant by the entirety; or, with surviving
spouse, as community property? . . . .
If “Yes,” attach Schedule E, Form 706.
6 a
Had the decedent ever been a citizen or resident
of the United States? See instructions . . .
b
If “Yes,” did the decedent lose U.S. citizenship or
residency within 10 years of death? See instructions
7
Did the decedent make any transfer (of
property that was located in the United States
at either the time of the transfer or the time of
death) described in section 2035, 2036, 2037,
or 2038? See the instructions for Form 706,
Schedule G . . . . . . . . . . .
Yes No
If “Yes,” attach Schedule G, Form 706.
8
At the date of death, were there any trusts in
existence that were created by the decedent
and that included property located in the
United States either when the trust was
created or when the decedent died? . . .
If “Yes,” attach Schedule G, Form 706.
9 At the date of death, did the decedent:
a Have a general power of appointment over
any property located in the United States? .
b Or, at any time, exercise or release the power?
If “Yes” to either a or b, attach Schedule H,
Form 706.
10a Have federal gift tax returns ever been filed? .
b
Periods covered
▶
c IRS offices where filed
▶
11
Does the gross estate in the United States
include any interests in property transferred to
a “skip person” as defined in the instructions
for Schedule R of Form 706? . . . . .
If “Yes,” attach Schedules R and/or R-1, Form 706.
Schedule A. Gross Estate in the United States (see instructions)
Yes No
Do you elect to value the decedent’s gross estate at a date or dates after the decedent’s death (as authorized by section 2032)?
▶
To make the election, you must check this box ‘‘Yes.’’ If you check ‘‘Yes,’’ complete all columns. If you check ‘‘No,’’ complete
columns (a), (b), and (e); you may leave columns (c) and (d) blank or you may use them to expand your column (b) description.
(a)
Item
no.
(b)
Description of property and securities
For securities, give CUSIP number
(c)
Alternate
valuation date
(d)
Alternate value in
U.S. dollars
(e)
Value at date of
death in U.S. dollars
(If you need more space, attach additional sheets of same size.)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule B. Taxable Estate (Caution: You must document lines 2 and 4 for the deduction on line 5 to be allowed.)
1 Gross estate in the United States (Schedule A total) . . . . . . . . . . . . . . . . . 1
2 Gross estate outside the United States (see instructions) . . . . . . . . . . . . . . . 2
3 Entire gross estate wherever located. Add amounts on lines 1 and 2 . . . . . . . . . . . 3
4 Amount of funeral expenses, administration expenses, decedent’s debts, mortgages and liens, and
losses during administration. Attach itemized schedule (see instructions) . . . . . . . . . . 4
5 Deduction for expenses, claims, etc. Divide line 1 by line 3 and multiply the result by line 4 . . . . 5
6 Charitable deduction (attach Schedule O, Form 706) and marital deduction (attach Schedule M, Form
706, and computation) . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 State death tax deduction (see instructions) . . . . . . . . . . . . . . . . . . . 7
8 Total deductions. Add lines 5, 6, and 7 . . . . . . . . . . . . . . . . . . . . . 8
9 Taxable estate. Subtract line 8 from line 1. Enter here and on line 1 of Part II . . . . . . . . . 9
Form 706-NA (Rev. 6-2019)
