Form 8971 Information Regarding Beneficiaries Acquiring Property f

FORM

8971

(January 2016)

Information Regarding Beneficiaries
Acquiring Property from a Decedent

OMB 1545-XXXX

►Information about Form 8971 and its separate instructions is at
www.irs.gov/form8971
Department of the Treasury
Internal Revenue Service

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
V

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
of the additional executors.

and attach a statement showing the names, addresses, telephone numbers, and TINs

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 such 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

C
Address
City, State, ZIP

B
TIN

D
Date of
Service

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.
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)?

Paid
Preparer
Use Only

Print/Type preparer’s name

Firm’s name►
Firm’s address►

Preparer’s signature

Yes
Date

No
Check
PTIN
if SelfEmployed
Firm’s EIN►
Phone No.

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FORM 8971
SCHEDULE A

Information for Beneficiary
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 I – General Information
1 Decedent’s name

2 Decedent’s SSN
-----

5 Executor’s name

3 Beneficiary’s name

4 Beneficiary’s TIN

V

6 Executor’s phone no.

7 Executor’s Address

Part II – Information on Property Acquired
A

B

C

D

E

Item
No.

Description of property acquired from the decedent and the Schedule
and item number where reported on the decedent’s Form 706. If the
beneficiary acquired a partial interest in the property, indicate the
percentage acquired here.

Did this
asset
increase
estate tax
liability?
(Y/N)

Valuation
Date

Estate Tax
Value
(in U.S.
dollars)

1

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.

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Page ____ of ____

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 I – General Information
1 Decedent’s name
5 Executor’s name

2 Decedent’s SSN
----V
6 Executor’s phone no.

3 Beneficiary’s name

4 Beneficiary’s TIN

7 Executor’s Address

Part II — Information on Property Acquired
A

B

C

D

E

Item
No.

Description of property acquired from the decedent and the Schedule
and item number where reported on the decedent’s Form 706. If
there is a partial interest in any property, indicated the percentage
acquired by the beneficiary here.

Did this
asset
increase
the estate
tax
liability?
(Y/N)

Valuation
Date

Estate Tax
Value

(continue
from
previous
page)

(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.
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