Form 8971
(January 2016)
Department of the Treasury
Internal Revenue Service
Information Regarding Beneficiaries
Acquiring Property From a Decedent
Information about Form 8971 and its separate instructions is at www.irs.gov/form8971.
OMB No. 1545-2264
Check box if this is a supplemental filing
Part I
Decedent and Executor Information
1 Decedent's name 2 Decedent's date of death
3 Decedent's SSN
4 Executor's name (see instructions) 5 Executor's phone no. 6 Executor's TIN
7 Executor's address (number and street including apartment or suite no.; city, town, or post office; state or province; country; and
ZIP or foreign postal code)
8 If there are multiple executors, check here and attach a statement showing the names, addresses, telephone numbers, and
TINs of the additional executors.
9 If the estate elected alternate valuation, indicate the alternate valuation date:
Part II
Beneficiary Information
How many beneficiaries received (or are expected to receive) property from the estate? For each beneficiary, provide
the information requested below. If more space is needed, attach a statement showing the requested information for the additional
beneficiaries.
A
Name of Beneficiary
B
TIN
C
Address, City, State, ZIP
D
Date Provided
Notice to Executors:
Submit Form 8971 with a copy of each completed Schedule A to the IRS. To protect privacy, Form 8971 should not be provided to any
beneficiary. Only Schedule A of Form 8971 should be provided to the beneficiary. Retain copies of all forms for the estate's records.
Sign
Here
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, all information reported herein is true, correct, and complete.
Signature of executor
Date
May the IRS discuss this return with the preparer shown below? See instructions . . . . . . . . . . . . . .
Yes
No
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm’s EIN
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 37794V
Form 8971 (1-2016)
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Form 8971 (1-2016)
SCHEDULE A—Information Regarding Beneficiaries Acquiring Property From a Decedent
Information about Form 8971 (including Schedule A) and its separate instructions is at www.irs.gov/form8971.
Check box if this is a supplemental filing
Part 1. General Information
1 Decedent's name
2 Decedent’s SSN
3 Beneficiary's name 4 Beneficiary's TIN
5 Executor's name 6 Executor's phone no.
7 Executor's address
Part 2. Information on Property Acquired
A
Item
No.
B
Description of property acquired from the decedent and the Schedule and item
number where reported on the decedent's Form 706, United States Estate (and
Generation-Skipping Transfer) Tax Return. If the beneficiary acquired a partial
interest in the property, indicate the interest acquired here.
C
Did this
asset
increase
estate tax
liability?
(Y/N)
D
Valuation
Date
E
Estate Tax
Value
(in U.S.
dollars)
Form 706, Schedule , Item
Description —
Notice to Beneficiaries:
You have received this schedule to inform you of the value of property you received from the estate of the decedent named above.
Retain this schedule for tax reporting purposes. If the property increased the estate tax liability, Internal Revenue Code section
1014(f) applies, requiring the consistent reporting of basis information. For more information on determining basis, see IRC section
1014 and/or consult a tax professional.
Page A-1
1
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Page of
Form 8971 (1-2016)
SCHEDULE A—Continuation Sheet
Use only if you need additional space to report property acquired (or expected to be acquired) by the beneficiary.
Check box if this is a supplemental filing
Part 1. General Information
1 Decedent's name
2 Decedent’s SSN
3 Beneficiary's name 4 Beneficiary's TIN
5 Executor's name 6 Executor's phone no.
7 Executor's address
Part 2. Information on Property Acquired
A
Item
No.
(continue
from
previous
page)
B
Description of property acquired from the decedent and the Schedule and item
number where reported on the decedent's Form 706, United States Estate (and
Generation-Skipping Transfer) Tax Return. If the beneficiary acquired a partial
interest in the property, indicate the interest acquired here.
C
Did this
asset
increase
estate tax
liability?
(Y/N)
D
Valuation
Date
E
Estate Tax
Value
(in U.S.
dollars)
Notice to Beneficiaries:
You have received this schedule to inform you of the value of property you received from the estate of the decedent named above.
Retain this schedule for tax reporting purposes. If the property increased the estate tax liability, Internal Revenue Code section
1014(f) applies, requiring the consistent reporting of basis information. For more information on determining basis, see IRC section
1014 and/or consult a tax professional.
Page A-2
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