!"#"$% &' (!

")"
!"#$%&'$ ( ")*+,-.-/)0 )1 2.3.456 7/1-8 (/0123450- 6#,078.#7 50 6#376* (7.. 5076#3165"07*

!"#$ %&' ()&&'*

"

*+,-./-++,0

9".7 6:. ;,23. "8 ,0< 56.$ 2576.4 "0 =1:.432. > #.82.16 ,0< ;,23,65"0 4571"306? /8 @A.7B@ ,66,1: .CD2,0,65"0 EEEEEEEEEEEEEE A.7

+,-. !
F"

G:.1H :.#. 58 <"3 .2.16 304.# 7.165"0 I)'(1*()*(J* 6" 6#.,6 ,0< 6#,078.#7 $,4. 6:57 <.,# 6" , K3,2585.4 63565"0 D#"-#,$ ,7 $,4. #,6,L2< ";.# , IM<.,#
D.#5"4 L.-50050- 6:57 <.,#N =.. 5076#3165"07N >66,1: .CD2,0,65"0N

$%&' ( ) *+,'- ./0123' 4567 '8 *+,' 9%:; O5867 2.77 D"25651,2 "#-,05P,65"0B $.451,2B ,04 .431,65"0,2 .C12375"07N (7.. 5076#3165"07*
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

233 24"43)354 6

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

233 24"43)354 ,

98'%6 8, $%&' (; >44 ,$"3067 8#"$ +,#6 UB 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

,+7***'

$%&' ! ) =+&23' .A+B-; O5867 6:,6 ,#. 45#.16 7H5D7 ,04 ,#. 73LS.16 6" L"6: -586 6,C ,04 -.0.#,65"0M7H5DD50- 6#,078.# 6,CN A"3 $376 2576 6:. -5867 50 1:#"0"2"-51,2 "#4.#N
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<
)XY)(L*
.2.165"0
"36

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

98'%6 8, $%&' !; >44 ,$"3067 8#"$ +,#6 )B 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

$%&' C ) D5E+&23' .A+B-; O5867 6" 6#3767 6:,6 ,#. 13##.062< 73LS.16 6" -586 6,C ,04 $,< 2,6.# L. 73LS.16 6" -.0.#,65"0M7H5DD50- 6#,078.# 6,CN A"3 $376 2576 6:.7. -5867 50
1:#"0"2"-51,2 "#4.#N
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<
)XY)(1*
.2.165"0

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

98'%6 8, $%&' C; >44 ,$"3067 8#"$ +,#6 YB 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

(If more space is needed, attach additional sheets of same size.)
FEGGHH
HDIHGIEF

6+8/*88* 686+9* (6666:

,
,**;'*8*8* (!")"7 !"#"$% &'

J
C"*(

9:;

1DEEF4

(6666:<6

!"#$ %&' ()&&'*

!"#"$% &' (!")"

*+,-./-++,0

+,-. !

"#$% & ' (#)#*+, -./% 0,1231.+.#%.23

4 /"0,1 2,13. "4 -5406 "4 7"8"#9 :77 0"0,16 4#"$ ;"13$8 < "4 +,#06 => )> ,87 ? @@@@@@@@@@@@@@@@@@@@@@@

5 /"0,1 ,883,1 .A;1365"86 4"# -5406 1560.7 "8 158. = (6.. 5860#3;05"86* @@@@@@@@@@@@@@@@@@@@@@@@@@@

! /"0,1 58;137.7 ,$"380 "4 -54069 B3C0#,;0 158. ) 4#"$ 158. = @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

,+1***'
,+1***'
*'

6,781%.239 (6.. 5860#3;05"86*

& D5406 "4 580.#.606 0" 6E"36. 4"# FG5;G , $,#50,1 7.73;05"8 F511 C. ;1,5$.7>
C,6.7 "8 50.$ 83$C.#6
"4 B;G.731. : @@@
: HA;1365"86 ,00#5C30,C1. 0" -5406 "8 158. I @@@@@@@@@@@@@@@@@@@@@@
; J,#50,1 7.73;05"89 B3C0#,;0 158. K 4#"$ 158. I @@@@@@@@@@@@@@@@@@@@

&

< LG,#50,C1. 7.73;05"8> C,6.7 "8 50.$ 8"69

<

1.66 .A;1365"86 @

:
;

= /"0,1 7.73;05"869 :77 158.6 M ,87 % @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

> B3C0#,;0 158. N 4#"$ 158. ? @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

4? D.8.#,05"8O6P5EE58- 0#,864.# 0,A.6 E,Q,C1. F50G 0G56 !"#$ %&' (4#"$ B;G.731. L> +,#0 ?> ;"19 <> /"0,1* @@@@@@@@@@@
44 (#)#*+, @./%9A :77 158.6 ' ,87 =&9 H80.# G.#. ,87 "8 E,-. => +,#0 ) O /,A L"$E30,05"8> 158. = RRRRRRRRRRRRRRR

4?

*'

>

*'

44

(,$B.3#*+, C3%,$,9% DE(C"F G#$.%#+ 6,781%.23A (B.. 5860#3;05"86 4"# B;G.731. :> +,#0 I> 158. I9*
S4 , 0#360 ("# "0G.# E#"E.#0Q* $..06 0G. #.T35#.$.806 "4 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*> ,87U
#A /G. 0#360 ("# "0G.# E#"E.#0Q* 56 1560.7 "8 B;G.731. :> ,87
*A /G. 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 56 .80.#.7 58 FG"1. "# 58 E,#0 ,6 , 7.73;05"8 "8 B;G.731. :> +,#0 I> 158. I> 0G.8 0G. 7"8"# 6G,11 C. 7..$.7 0" G,2.
$,7. ,8 .1.;05"8 0" G,2. 63;G 0#360 ("# "0G.# E#"E.#0Q* 0#.,0.7 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*9
S4 1.66 0G,8 0G. .805#. 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 0G,0 0G. 7"8"# G,6 58;137.7 58 +,#06 = ,87 ? "4 B;G.731. : 56 .80.#.7 ,6 , 7.73;05"8 "8 158. I> 0G. 7"8"#
6G,11 C. ;"8657.#.7 0" G,2. $,7. ,8 .1.;05"8 "81Q ,6 0" , 4#,;05"8 "4 0G. 0#360 ("# "0G.# E#"E.#0Q*9 /G. 83$.#,0"# "4 0G56 4#,;05"8 56 .T3,1 0" 0G. ,$"380 "4 0G. 0#360
("# "0G.# E#"E.#0Q* 7.73;0.7 "8 B;G.731. :> +,#0 I> 158. M9 /G. 7.8"$58,0"# 56 .T3,1 0" 0G. 0"0,1 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 1560.7 58 +,#06 = ,87 ? "4
B;G.731. :9
S4 Q"3 $,P. 0G. V/S+ .1.;05"8> 0G. 0.#$58,C1. 580.#.60 E#"E.#0Q 582"12.7 F511 C. 58;137.7 58 Q"3# 6E"36.W6 -#"66 .60,0. 3E"8 G56 "# G.# 7.,0G (6.;05"8 )&II*9 B..
5860#3;05"86 4"# 158. I "4 B;G.731. :9 S4 Q"3# 6E"36. 756E"6.6 (CQ -540 "# "0G.#F56.* "4 ,11 "# E,#0 "4 0G. T3,154Q58- 154. 58;"$. 580.#.60> G. "# 6G. F511 C. ;"8657.#.7 0"
G,2. $,7. , 0#,864.# "4 0G. .805#. E#"E.#0Q 0G,0 56 63CX.;0 0" 0G. -540 0,A9 B.. Transfer of Certain Life Estates Received From Spouse"8 E,-. I "4 0G. 5860#3;05"869

45 H+,1%.23 I8% 2/ E(C" ($,#%B,3% 2/ J338.%.,9

LG.;P G.#. 54 Q"3 .1.;0 387.# 6.;05"8 )K)?(4*(M* 32% 0" 0#.,0 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q ,8Q X"580 ,87 63#252"# ,883505.6 0G,0 ,#. #.E"#0.7

"8 B;G.731. : ,87 F"317 "0G.#F56. C. 0#.,0.7 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*9 B.. 5860#3;05"869 H80.# 0G. 50.$ 83$C.#6 4#"$
B;G.731. : 4"# 0G. ,883505.6 4"# FG5;G Q"3 ,#. $,P58- 0G56 .1.;05"8 Y

!"#$%&'$ (

)*+,- ./01 2/*0/ 23/*04-

C/ K28 #39L,$,7 MN,9M 23 +.3, 44# 2/ O#@, 4P "#$% 4P 9,, %Q, .39%$81%.239 /2$ 12BO+,%.3@ R1Q,78+, SA C/ K28 #39L,$,7 MT2PM 9U.O %2 %Q, (#) V2BO8%#%.23 23 O#@, 4
D2$ R1Q,78+, VP ./ #OO+.1#*+,FA
J
S
V
6
H
!"#$%& #' $%('()*
!"#$%& #' /1)+('(+
S80.#8,1 Z.2.83. "445;.
:$"380 "4
L,1.87,# Q.,# "#
+,)*(& -.-(%/& .('&
)0)"1&(#% '#, 1,(#,
FG.#. E#5"# #.03#8 F,6 451.7
0,A,C1. -5406
;,1.87,# T3,#0.#
&-0 '#, 1),(#*/ -'&),
1),(#*/ )%*(%. 3)'#,)
(6.. 5860#3;05"86*
2)+)"3), 456 5789
:-%$-,; 56 5788

,**2
,**/

$34$344"531 (&
$34$344"531 (&

+0666
+0666

4 /"0,16 4"# E#5"# E.#5"76 @@@@@@@@@@@@@@@@@@@@

*'
*'

*'

5 :$"380> 54 ,8Q> CQ FG5;G 0"0,1 6E.;545; .A.$E05"8> 158. => ;"13$8 [> 56 $"#. 0G,8 \?&>&&& @@@@@@@@@@@@@@@@@

! /"0,1 ,$"380 "4 0,A,C1. -5406 4"# E#5"# E.#5"769 :77 ,$"380 "8 158. => ;"13$8 H ,87 ,$"380> 54 ,8Q> "8 158. )9
H80.# G.#. ,87 "8 E,-. => +,#0 ) O /,A L"$E30,05"8> 158. ) RRRRRRRRRRRRRRRRRRRRRRRRRRRRRR
(If more space is needed, attach additional sheets of same size.)

7?AA>5
5>B5AB?7

7+8/*88* 787+2* (77779

8
,**6'*8*8* (!")"1 !"#"$% &'

*'
<#,"

567 =>??7@

(77779:7

!"#"$% &' (!")"

/!567896 ! !"#$%&'&(") "* +,),-'&(")./0($$()1 2-')3*,- 2'4

*+,-./-++,0

!"#$ %&' ()&&'*

+,-. !

"#$%. /01.# 232"4 53#.61 47384 19,1 ,#. 6"$8:.1.:; .<6:=5.5 >; 19. ?@A .<.$813"0 $=41 413:: >. B=::; #.8"#1.5 (306:=530- 2,:=. ,05 .<.$813"04 6:,3$.5* "0 @69.5=:. CD
&'($ ) * +%,%('$-#,*./-00-,1 2(',34%(3
5
/1.$ E"D
(B#"$ @69.5=:. FG
+,#1 )G 6":D F*

6
H,:=. (B#"$ @69.5=:. FG
+,#1 )G 6":D I*

7
E"01,<,>:.
8"#13"0 "B 1#,04B.#

8
E.1 A#,04B.# (4=>1#,61
6":D C B#"$ 6":D J*

?3B14 $,5. >; 48"=4. (B"# -3B1 48:31130- "0:;*

&'($ 9 * +.2 :;%<0$-#, =%>#,>-?-'$-#, @.%>$-#, 9AB)C ',D .%>$-#, 9AE9@'C@BC :?%>$-#,
C9.67 9.#. K

3B ;"= ,#. $,730- , 4.613"0 )LM)(,*(N* (48.63,: OA/+* .:.613"0 (4.. 3041#=613"04*

P01.# 19. 31.$ 0=$>.#4 B#"$ @69.5=:. F "B 19. -3B14 B"# Q9369 ;"= ,#. $,730- 1934 .:.613"0 K
) R,<3$=$ ,::"Q,>:. .<.$813"0 (4.. 3041#=613"04* SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

9 A"1,: .<.$813"0 =4.5 B"# 8.#3"54 >.B"#. B3:30- 1934 #.1=#0 SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

B P<.$813"0 ,2,3:,>:. B"# 1934 #.1=#0D @=>1#,61 :30. ) B#"$ :30. T SSSSSSSSSSSSSSSSSSSSSSSSSSSSS

! P<.$813"0 6:,3$.5 "0 1934 #.1=#0 B#"$ +,#1 NG 6":=$0 C 1"1,:G >.:"Q SSSSSSSSSSSSSSSSSSSSSSSSSS

E F=1"$,136 ,::"6,13"0 "B .<.$813"0 1" 1#,04B.#4 #.8"#1.5 "0 @69.5=:. FG +,#1 N (4.. 3041#=613"04* SSSSSSSSSSSSSS

A P<.$813"0 ,::"6,1.5 1" 1#,04B.#4 0"1 49"Q0 "0 :30. U "# MG ,>"2.D H#I <I3$ '$$'>J ' K"#$->% #4 5??#>'$-#,LK (4.. 3041#=613"04* S

F F55 :30.4 UG MG ,05 L SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

G P<.$813"0 ,2,3:,>:. B"# B=1=#. 1#,04B.#4D @=>1#,61 :30. % B#"$ :30. N VVVVVVVVVVVVVVVVVVVVVVVVVVV
G
&'($ B * 2'; 7#<0I$'$-#,
5
6
:
M
+
7
8
/1.$ E"D
E.1 1#,04B.#
/06:=43"0 X,13" R,<3$=$ F88:36,>:. X,1.
(B#"$
?@A P<.$813"0
W3235. 6":D C
(B#"$
@69.5=:.
CG
(4=>1#,61
6":D
W
P41,1.
A,<
($=:138:;
6":D P
@69.5=:. CG
F::"6,1.5
>; 6":D J
+,#1 TG 6":D W*
B#"$ TD&&&*
X,1.
>; 6":D !*
+,#1 T*

120**2***'

120**2***'

120**2***'
N
?.0.#,13"0Y@738830A#,04B.# A,<
($=:138:; 6":D J >; 6":D ?*

UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
?3B14 $,5. >; 48"=4. (B"# -3B1 48:31130- "0:;*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
2#$'? 1%,%('$-#,*3/-00-,1 $(',34%( $';L P01.# 9.#.[ "0 8,-. NG

A"1,: .<.$813"0 6:,3$.5D P01.# 9.#. ,05

@69.5=:. FG +,#1 UG :30. T&[ ,05 "0 8,-. TG +,#1 ) Y A,<
"0 +,#1 )G :30. UG ,>"2.D R,; 0"1 .<6..5
+,#1 )G :30. NG ,>"2. VVVVVVVVV
C"$8=1,13"0G :30. TL VVVVVVVVVVVVVVVVVVV
(If more space is needed, attach additional sheets of same size.)
('**+,
,&-,*-'(

3+1/*11* 313+4* (33335

+
,**6'*1*1* (!")"2 !"#"$% &'

!"#$

:;<

%&''()

(3333573

90$0*I += #90%0
'?<F@JF??<>
666666666666666
66666666666
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
"#$% &'(
)*+,-./, 01 20$3 4
)303,%,53
4
666666666666666666666666666666666666666666666666666666666666666666666666666666
73,%
0-8.)3,5# -,)*$7237#5
90)7)
-03,
6666 66666666666
6666666666 66666666
4 %0/70 0= #90%0
>'?@ )= A$,,5B##*+7*0A#1 7/ @'@4>
-0.A+3,$
-#5#$ ,/,*3,- .5-,$
),*37#5
><(C*DC<DC9D #" 3+,
*#-, 3# 3$,03 0
<''& A7"3 0) +0:75A
9,,5 %0-, $0309/E
#:,$ 0 >FE,0$
2,$7#- 9,A75575A 75
<''&=
),, ,/,*37#5 %0-,
B73+ 30G20E,$H)
<''& A7"3 30G
$,3.$5=
<

:0/.,
666666666

)2/73 4;<
666666666

5,3
3$05)",$
666666666

4<1'''= '4;'4;'(

4<1'''=

@1'''=

@1'''=

4<1'''= '4;'4;'(

4<1'''=

@1'''=

@1'''=
6666666666
4<1'''=
!!!!!!!!!!

5030)+0 %= #90%0
>'?@ )= A$,,5B##*+7*0A#1 7/ @'@4>
-0.A+3,$
-#5#$ ,/,*3,- .5-,$
),*37#5
><(C*DC<DC9D #" 3+,
*#-, 3# 3$,03 0
<''& A7"3 0) +0:75A
9,,5 %0-, $0309/E
#:,$ 0 >FE,0$
2,$7#- 9,A75575A 75
<''&=
),, ,/,*37#5 %0-,
B73+ 30G20E,$H)
<''& A7"3 30G
$,3.$5=

3#30/

4?KJ'KK' 4K4?&' #4444-

>
<''(='K'K' #90%01 90$0*I +=

)303,%,53C)D 4
#4444-L4

70$0*I +? #70%0
'A:FBJFAA:@
;;;;;;;;;;;;;;;
;;;;;;;;;;;
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
"#$% &'(
)*+,-./, 01 20$3 41 56"3) %0-, 78 )2#.),
)303,%,93
:
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
63,%
0-<.)3,9# -,)*$6236#9
70)6)
-03,
;;;; ;;;;;;;;;;;
;;;;;;;;;; ;;;;;;;;
4 %0/60 0? #70%0
@'AB )? 5$,,9C##*+6*05#1 6/ B'B4@
-0.5+3,$
-#9#$ ,/,*3,- .9-,$
),*36#9
@:(D*ED:ED7E #" 3+,
*#-, 3# 3$,03 0
:''& 56"3 0) +0=695
7,,9 %0-, $0307/8
#=,$ 0 @F8,0$
2,$6#- 7,5699695 69
:''&?
),, ,/,*36#9 %0-,
C63+ 30G208,$H)
:''& 56"3 30G
$,3.$9?
:

=0/.,
;;;;;;;;;

)2/63 4>:
;;;;;;;;;

9,3
3$09)",$
;;;;;;;;;

4:1'''? '4>'4>'(

4:1'''?

B1'''?

B1'''?

4:1'''? '4>'4>'(

4:1'''?

B1'''?

B1'''?
;;;;;;;;;;
4:1'''?
!!!!!!!!!!

9030)+0 %? #70%0
@'AB )? 5$,,9C##*+6*05#1 6/ B'B4@
-0.5+3,$
-#9#$ ,/,*3,- .9-,$
),*36#9
@:(D*ED:ED7E #" 3+,
*#-, 3# 3$,03 0
:''& 56"3 0) +0=695
7,,9 %0-, $0307/8
#=,$ 0 @F8,0$
2,$6#- 7,5699695 69
:''&?
),, ,/,*36#9 %0-,
C63+ 30G208,$H)
:''& 56"3 30G
$,3.$9?

3#30/ )*+,-./, 01 20$3 41 56"3) %0-, 78 )2#.),

4AKJ'KK' 4K4A&' #4444-

B
:''(?'K'K' #70%01 70$0*I +?

)303,%,93D)E :
#4444-L4

!"#$%&&% &' ()*!*

!"#$%&'$ ( ")*+,-.-/)0 )1 2.3.456 7/1-8 (/0123450- 6#,078.#7 50 6#376* (7.. 5076#3165"07*

!"#$ %&' ()&&'*

"

+,-./-.0+-0

9".7 6:. ;,23. "8 ,0< 56.$ 2576.4 "0 =1:.432. > #.82.16 ,0< ;,23,65"0 4571"306? /8 @A.7B@ ,66,1: .CD2,0,65"0 EEEEEEEEEEEEEE A.7

+,-. !
F"

G:.1H :.#. 58 <"3 .2.16 304.# 7.165"0 I)'(1*()*(J* 6" 6#.,6 ,0< 6#,078.#7 $,4. 6:57 <.,# 6" , K3,2585.4 63565"0 D#"-#,$ ,7 $,4. #,6,L2< ";.# , IM<.,#
D.#5"4 L.-50050- 6:57 <.,#N =.. 5076#3165"07N >66,1: .CD2,0,65"0N

$%&' ( ) *+,'- ./0123' 4567 '8 *+,' 9%:; O5867 2.77 D"25651,2 "#-,05P,65"0B $.451,2B ,04 .431,65"0,2 .C12375"07N (7.. 5076#3165"07*
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

2%% 23*3%!%43 +

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

2%% 23*3%!%43 5

98'%6 8, $%&' (; >44 ,$"3067 8#"$ +,#6 UB 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

056---'

$%&' ! ) =+&23' .A+B-; O5867 6:,6 ,#. 45#.16 7H5D7 ,04 ,#. 73LS.16 6" L"6: -586 6,C ,04 -.0.#,65"0M7H5DD50- 6#,078.# 6,CN A"3 $376 2576 6:. -5867 50 1:#"0"2"-51,2 "#4.#N
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<
)XY)(L*
.2.165"0
"36

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

98'%6 8, $%&' !; >44 ,$"3067 8#"$ +,#6 )B 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

$%&' C ) D5E+&23' .A+B-; O5867 6" 6#3767 6:,6 ,#. 13##.062< 73LS.16 6" -586 6,C ,04 $,< 2,6.# L. 73LS.16 6" -.0.#,65"0M7H5DD50- 6#,078.# 6,CN A"3 $376 2576 6:.7. -5867 50
1:#"0"2"-51,2 "#4.#N
"
/6.$
03$L.#

#
#'($ '#) '))*$&&
Q !"#$$%&
-" )"#"* 1.2 '#34
Q +$,'-."#&/.0
"2 6.2Q !$&5*.0-."#
6.2- 8'& "2 &$59*.-.$&: 6.;$ <=>7? #"@
Q 7272 -/$
5,"&$,3
/$,)
$#-.-3: 6.;$ A7B
Q

<
)XY)(1*
.2.165"0

=
9"0"#R7 ,4S376.4
L,757 "8 -586

>
9,6.
"8 -586

?
T,23. ,6
4,6. "8 -586

*
!"# 7D256 -5867B
.06.# UV) "8
1"23$0 !

@
F.6 6#,078.#
(73L6#,16 1"2N O
8#"$ 1"2N !*

O5867 $,4. L< 7D"37. M complete 8567 if you are splitting gifts with your spouse and he/she also made gifts.

98'%6 8, $%&' C; >44 ,$"3067 8#"$ +,#6 YB 1"23$0 W EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

(If more space is needed, attach additional sheets of same size.)
FEGGHH
HDIHGIEF

75+8-++- 7+759- (7777:

8
0--;'-+-+- ()*!*6 )*<*#= $'

J
C"*(

9:;

1DEEF4

(7777:>7

!"#$ %&' ()&&'*

!"#$%&&% &' ()*!*

+,-./-.0+-0

+,-. !

"#$% & ' (#)#*+, -./% 0,1231.+.#%.23

4 /"0,1 2,13. "4 -5406 "4 7"8"#9 :77 0"0,16 4#"$ ;"13$8 < "4 +,#06 => )> ,87 ? @@@@@@@@@@@@@@@@@@@@@@@

5 /"0,1 ,883,1 .A;1365"86 4"# -5406 1560.7 "8 158. = (6.. 5860#3;05"86* @@@@@@@@@@@@@@@@@@@@@@@@@@@

! /"0,1 58;137.7 ,$"380 "4 -54069 B3C0#,;0 158. ) 4#"$ 158. = @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

012---'
012---'
-'

6,781%.239 (6.. 5860#3;05"86*

& D5406 "4 580.#.606 0" 6E"36. 4"# FG5;G , $,#50,1 7.73;05"8 F511 C. ;1,5$.7>
C,6.7 "8 50.$ 83$C.#6
"4 B;G.731. : @@@
: HA;1365"86 ,00#5C30,C1. 0" -5406 "8 158. I @@@@@@@@@@@@@@@@@@@@@@
; J,#50,1 7.73;05"89 B3C0#,;0 158. K 4#"$ 158. I @@@@@@@@@@@@@@@@@@@@

&

< LG,#50,C1. 7.73;05"8> C,6.7 "8 50.$ 8"69

<

1.66 .A;1365"86 @

:
;

= /"0,1 7.73;05"869 :77 158.6 M ,87 % @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

> B3C0#,;0 158. N 4#"$ 158. ? @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

4? D.8.#,05"8O6P5EE58- 0#,864.# 0,A.6 E,Q,C1. F50G 0G56 !"#$ %&' (4#"$ B;G.731. L> +,#0 ?> ;"19 <> /"0,1* @@@@@@@@@@@
44 (#)#*+, @./%9A :77 158.6 ' ,87 =&9 H80.# G.#. ,87 "8 E,-. => +,#0 ) O /,A L"$E30,05"8> 158. = RRRRRRRRRRRRRRR

4?

-'

>

-'

44

(,$B.3#*+, C3%,$,9% DE(C"F G#$.%#+ 6,781%.23A (B.. 5860#3;05"86 4"# B;G.731. :> +,#0 I> 158. I9*
S4 , 0#360 ("# "0G.# E#"E.#0Q* $..06 0G. #.T35#.$.806 "4 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*> ,87U
#A /G. 0#360 ("# "0G.# E#"E.#0Q* 56 1560.7 "8 B;G.731. :> ,87
*A /G. 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 56 .80.#.7 58 FG"1. "# 58 E,#0 ,6 , 7.73;05"8 "8 B;G.731. :> +,#0 I> 158. I> 0G.8 0G. 7"8"# 6G,11 C. 7..$.7 0" G,2.
$,7. ,8 .1.;05"8 0" G,2. 63;G 0#360 ("# "0G.# E#"E.#0Q* 0#.,0.7 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*9
S4 1.66 0G,8 0G. .805#. 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 0G,0 0G. 7"8"# G,6 58;137.7 58 +,#06 = ,87 ? "4 B;G.731. : 56 .80.#.7 ,6 , 7.73;05"8 "8 158. I> 0G. 7"8"#
6G,11 C. ;"8657.#.7 0" G,2. $,7. ,8 .1.;05"8 "81Q ,6 0" , 4#,;05"8 "4 0G. 0#360 ("# "0G.# E#"E.#0Q*9 /G. 83$.#,0"# "4 0G56 4#,;05"8 56 .T3,1 0" 0G. ,$"380 "4 0G. 0#360
("# "0G.# E#"E.#0Q* 7.73;0.7 "8 B;G.731. :> +,#0 I> 158. M9 /G. 7.8"$58,0"# 56 .T3,1 0" 0G. 0"0,1 2,13. "4 0G. 0#360 ("# "0G.# E#"E.#0Q* 1560.7 58 +,#06 = ,87 ? "4
B;G.731. :9
S4 Q"3 $,P. 0G. V/S+ .1.;05"8> 0G. 0.#$58,C1. 580.#.60 E#"E.#0Q 582"12.7 F511 C. 58;137.7 58 Q"3# 6E"36.W6 -#"66 .60,0. 3E"8 G56 "# G.# 7.,0G (6.;05"8 )&II*9 B..
5860#3;05"86 4"# 158. I "4 B;G.731. :9 S4 Q"3# 6E"36. 756E"6.6 (CQ -540 "# "0G.#F56.* "4 ,11 "# E,#0 "4 0G. T3,154Q58- 154. 58;"$. 580.#.60> G. "# 6G. F511 C. ;"8657.#.7 0"
G,2. $,7. , 0#,864.# "4 0G. .805#. E#"E.#0Q 0G,0 56 63CX.;0 0" 0G. -540 0,A9 B.. Transfer of Certain Life Estates Received From Spouse"8 E,-. I "4 0G. 5860#3;05"869

45 H+,1%.23 I8% 2/ E(C" ($,#%B,3% 2/ J338.%.,9

LG.;P G.#. 54 Q"3 .1.;0 387.# 6.;05"8 )K)?(4*(M* 32% 0" 0#.,0 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q ,8Q X"580 ,87 63#252"# ,883505.6 0G,0 ,#. #.E"#0.7

"8 B;G.731. : ,87 F"317 "0G.#F56. C. 0#.,0.7 ,6 T3,1545.7 0.#$58,C1. 580.#.60 E#"E.#0Q 387.# 6.;05"8 )K)?(4*9 B.. 5860#3;05"869 H80.# 0G. 50.$ 83$C.#6 4#"$
B;G.731. : 4"# 0G. ,883505.6 4"# FG5;G Q"3 ,#. $,P58- 0G56 .1.;05"8 Y

!"#$%&'$ (

)*+,- ./01 2/*0/ 23/*04-

C/ K28 #39L,$,7 MN,9M 23 +.3, 44# 2/ O#@, 4P "#$% 4P 9,, %Q, .39%$81%.239 /2$ 12BO+,%.3@ R1Q,78+, SA C/ K28 #39L,$,7 MT2PM 9U.O %2 %Q, (#) V2BO8%#%.23 23 O#@, 4
D2$ R1Q,78+, VP ./ #OO+.1#*+,FA
J
S
V
6
H
!"#$%& #' $%('()*
!"#$%& #' /1)+('(+
S80.#8,1 Z.2.83. "445;.
:$"380 "4
L,1.87,# Q.,# "#
+,)*(& -.-(%/& .('&
)0)"1&(#% '#, 1,(#,
FG.#. E#5"# #.03#8 F,6 451.7
0,A,C1. -5406
;,1.87,# T3,#0.#
&-0 '#, 1),(#*/ -'&),
1),(#*/ )%*(%. 3)'#,)
(6.. 5860#3;05"86*
2)+)"3), 456 5789
:-%$-,; 56 5788

0--3
0--7

#"4#"44*5"2 ($
#"4#"44*5"2 ($

1,666
1,666

4 /"0,16 4"# E#5"# E.#5"76 @@@@@@@@@@@@@@@@@@@@

-'
-'

-'

5 :$"380> 54 ,8Q> CQ FG5;G 0"0,1 6E.;545; .A.$E05"8> 158. => ;"13$8 [> 56 $"#. 0G,8 \?&>&&& @@@@@@@@@@@@@@@@@

! /"0,1 ,$"380 "4 0,A,C1. -5406 4"# E#5"# E.#5"769 :77 ,$"380 "8 158. => ;"13$8 H ,87 ,$"380> 54 ,8Q> "8 158. )9
H80.# G.#. ,87 "8 E,-. => +,#0 ) O /,A L"$E30,05"8> 158. ) RRRRRRRRRRRRRRRRRRRRRRRRRRRRRR
(If more space is needed, attach additional sheets of same size.)

7?AA>5
5>B5AB?7

81+7-++- 8+813- (88889

6
0--6'-+-+- ()*!*2 )*:*#; $'

-'
<#,"

567 =>??7@

(88889<8

!"#$%&&% &' ()*!*

/!567896 ! !"#$%&'&(") "* +,),-'&(")./0($$()1 2-')3*,- 2'4

+,-./-.0+-0

!"#$ %&' ()&&'*

+,-. !

"#$%. /01.# 232"4 53#.61 47384 19,1 ,#. 6"$8:.1.:; .<6:=5.5 >; 19. ?@A .<.$813"0 $=41 413:: >. B=::; #.8"#1.5 (306:=530- 2,:=. ,05 .<.$813"04 6:,3$.5* "0 @69.5=:. CD
&'($ ) * +%,%('$-#,*./-00-,1 2(',34%(3
5
/1.$ E"D
(B#"$ @69.5=:. FG
+,#1 )G 6":D F*

6
H,:=. (B#"$ @69.5=:. FG
+,#1 )G 6":D I*

7
E"01,<,>:.
8"#13"0 "B 1#,04B.#

8
E.1 A#,04B.# (4=>1#,61
6":D C B#"$ 6":D J*

?3B14 $,5. >; 48"=4. (B"# -3B1 48:31130- "0:;*

&'($ 9 * +.2 :;%<0$-#, =%>#,>-?-'$-#, @.%>$-#, 9AB)C ',D .%>$-#, 9AE9@'C@BC :?%>$-#,
C9.67 9.#. K

3B ;"= ,#. $,730- , 4.613"0 )LM)(,*(N* (48.63,: OA/+* .:.613"0 (4.. 3041#=613"04*

P01.# 19. 31.$ 0=$>.#4 B#"$ @69.5=:. F "B 19. -3B14 B"# Q9369 ;"= ,#. $,730- 1934 .:.613"0 K
) R,<3$=$ ,::"Q,>:. .<.$813"0 (4.. 3041#=613"04* SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

9 A"1,: .<.$813"0 =4.5 B"# 8.#3"54 >.B"#. B3:30- 1934 #.1=#0 SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

B P<.$813"0 ,2,3:,>:. B"# 1934 #.1=#0D @=>1#,61 :30. ) B#"$ :30. T SSSSSSSSSSSSSSSSSSSSSSSSSSSSS

! P<.$813"0 6:,3$.5 "0 1934 #.1=#0 B#"$ +,#1 NG 6":=$0 C 1"1,:G >.:"Q SSSSSSSSSSSSSSSSSSSSSSSSSS

E F=1"$,136 ,::"6,13"0 "B .<.$813"0 1" 1#,04B.#4 #.8"#1.5 "0 @69.5=:. FG +,#1 N (4.. 3041#=613"04* SSSSSSSSSSSSSS

A P<.$813"0 ,::"6,1.5 1" 1#,04B.#4 0"1 49"Q0 "0 :30. U "# MG ,>"2.D H#I <I3$ '$$'>J ' K"#$->% #4 5??#>'$-#,LK (4.. 3041#=613"04* S

F F55 :30.4 UG MG ,05 L SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

G P<.$813"0 ,2,3:,>:. B"# B=1=#. 1#,04B.#4D @=>1#,61 :30. % B#"$ :30. N VVVVVVVVVVVVVVVVVVVVVVVVVVV
G
&'($ B * 2'; 7#<0I$'$-#,
5
6
:
M
+
7
8
/1.$ E"D
E.1 1#,04B.#
/06:=43"0 X,13" R,<3$=$ F88:36,>:. X,1.
(B#"$
?@A P<.$813"0
W3235. 6":D C
(B#"$
@69.5=:.
CG
(4=>1#,61
6":D
W
P41,1.
A,<
($=:138:;
6":D P
@69.5=:. CG
F::"6,1.5
>; 6":D J
+,#1 TG 6":D W*
B#"$ TD&&&*
X,1.
>; 6":D !*
+,#1 T*

+1,--1---'

+1,--1---'

+1,--1---'
N
?.0.#,13"0Y@738830A#,04B.# A,<
($=:138:; 6":D J >; 6":D ?*

UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
?3B14 $,5. >; 48"=4. (B"# -3B1 48:31130- "0:;*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
UMZ (DUM*
2#$'? 1%,%('$-#,*3/-00-,1 $(',34%( $';L P01.# 9.#.[ "0 8,-. NG

A"1,: .<.$813"0 6:,3$.5D P01.# 9.#. ,05

@69.5=:. FG +,#1 UG :30. T&[ ,05 "0 8,-. TG +,#1 ) Y A,<
"0 +,#1 )G :30. UG ,>"2.D R,; 0"1 .<6..5
+,#1 )G :30. NG ,>"2. VVVVVVVVV
C"$8=1,13"0G :30. TL VVVVVVVVVVVVVVVVVVV
(If more space is needed, attach additional sheets of same size.)
('**+,
,&-,*-'(

23+4-++- 2+235- (22226

20--7'-+-+- ()*!*1 )*8*#9 $'

!"#$

:;<

%&''()

(22226:2

/$7$*J +- ./$&$
1B423K2BB40
555555555555555
55555555555
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
&)*+%,,% ,- ./$&$ (0123124(14
"#$#%&%'#
(
55555555555555555555555555555
6.7& 819
"*+%:;,% $< =$7# >
555555555555555555555555555555555555555555555555555555555555555555555555555555
)#%&
$:?;"#%:
'. :%"*7)=#).'
/$")"
:$#%
5555 55555555555
5555555555 55555555
> &$,)$ $- ./$&$
01B3 "- C7%%'D..:
*+)*$C.< ), 313>0
:$;C+#%7
:.'.7 %,%*#%: ;':%7
"%*#).'
049E*FE4FE/F .6 #+%
*.:% #. #7%$# $
4118 C)6# $" +$@)'C
/%%' &$:% 7$#$/,G
.@%7 $ 02G%$7
=%7).: /%C)'')'C )'
4118"%% %,%*#).' &$:%
D)#+ #$H=$G%7I"
4118 C)6# #$H
7%#;7'4

@$,;%
555555555

"=,)# >A4
555555555

'%#
#7$'"6%7
555555555

>4<111- 1>A1>A19

>4<111-

3<111-

3<111-

>4<111- 1>A1>A19

>4<111-

3<111-

3<1115555555555
>4<111!!!!!!!!!!

'$#$"+$ &- ./$&$

01B3 "- C7%%'D..:
*+)*$C.< ), 313>0
:$;C+#%7
:.'.7 %,%*#%: ;':%7
"%*#).'
049E*FE4FE/F .6 #+%
*.:% #. #7%$# $
4118 C)6# $" +$@)'C
/%%' &$:% 7$#$/,G
.@%7 $ 02G%$7
=%7).: /%C)'')'C )'
4118"%% %,%*#).' &$:%
D)#+ #$H=$G%7I"
4118 C)6# #$H
7%#;7'-

#.#$,

>B(K1((1 >(>B81 .>>>>:

>>
4119-1(1(1 ./$&$< /$7$*J +-

"#$#%&%'#E"F (
.>>>>:L>

/$8$*J +- ./$&$
2(534K3((51
666666666666666
66666666666
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
&)*+%,,% ,- ./$&$ 01234235025
"#$#%&%'#
(
66666666666666666666666666666
7.8& 92:
"*+%;<,% $= >$8# ?= @)7#" &$;% /A ">.<"%
666666666666666666666666666666666666666666666666666666666666666666666666666666
)#%&
$;B<"#%;
'. ;%"*8)>#).'
/$")"
;$#%
6666 66666666666
6666666666 66666666
? &$,)$ $- ./$&$
12(4 "- @8%%'E..;
*+)*$@.= ), 424?1
;$<@+#%8
;.'.8 %,%*#%; <';%8
"%*#).'
15:F*GF5GF/G .7 #+%
*.;% #. #8%$# $
5229 @)7# $" +$C)'@
/%%' &$;% 8$#$/,A
.C%8 $ 13A%$8
>%8).; /%@)'')'@ )'
5229"%% %,%*#).' &$;%
E)#+ #$H>$A%8I"
5229 @)7# #$H
8%#<8'5

C$,<%
666666666

">,)# ?D5
666666666

'%#
#8$'"7%8
666666666

?5=222- 2?D2?D2:

?5=222-

4=222-

4=222-

?5=222- 2?D2?D2:

?5=222-

4=222-

4=2226666666666
?5=222!!!!!!!!!!

'$#$"+$ &- ./$&$

12(4 "- @8%%'E..;
*+)*$@.= ), 424?1
;$<@+#%8
;.'.8 %,%*#%; <';%8
"%*#).'
15:F*GF5GF/G .7 #+%
*.;% #. #8%$# $
5229 @)7# $" +$C)'@
/%%' &$;% 8$#$/,A
.C%8 $ 13A%$8
>%8).; /%@)'')'@ )'
5229"%% %,%*#).' &$;%
E)#+ #$H>$A%8I"
5229 @)7# #$H
8%#<8'-

#.#$, "*+%;<,% $= >$8# ?= @)7#" &$;% /A ">.<"%

?(0K2002 ?0?(92 .????;

?5
522:-20202 ./$&$= /$8$*J +-

"#$#%&%'#F"G (
.????;L?