Form Schedule A (Form 8 Schedule A (Form 8 Property Acquired by Surviving Spouse

Form 8939 (2010)

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Decedent’s Social Security Number

Estate of:

Number

of

SCHEDULE A—Property Acquired by Surviving Spouse
Complete a separate Schedule A for the surviving spouse and for any QTIP trust. See instructions.

Part I

General Information

1a Name of Executor

1b Executor’s address (number and street including

1c Executor’s social security number

apartment or suite number, city, town, or post office, state, and
ZIP code) and phone number.
Phone no. (

2a Name of Recipient

Part II Property Information
3

)

2b Recipient’s taxpayer identification number

For all property acquired from the decedent by the recipient named in line 2a the basis of which at the date of death is equal to or greater than
its fair market value at the date of death, provide the following information. See instructions.

Item No.

(a)
Accurate description
of the property

(b)
Date decedent
acquired the property
(mm/dd/yyyy)

(c)
Adjusted
basis at death

(d)
Fair market
value at
death

(e)
Check if any gain
would be ordinary
(Attach statement)

3a Total for columns (c) and (d)
4

Subtract the amount in line 3a, column (d) from the amount in line 3a, column (e)

5

For all property acquired from the decedent by the recipient named in line 2a the basis of which at the date of death is less than its fair market
value at the date of death, provide the following information. See instructions.

Item
No.

6

(a)
Accurate description
of the property

(b)
Check if qualified
terminable interest
property

(c)
Date decedent
acquired
the property
(mm/dd/yyyy)

(d)
Check if ineligible
property. Attach
statement. See
instructions.

(e)
Adjusted
basis at death

(f)
Fair market
value at
death

(g)
Basis
increase
allocated to
property

(h)
Amount of
gain that
would be ordinary
(Attach statement)

Add the amounts in line 5, column (g). Enter this amount on page 1, line 19

Schedule A—Page 2