Form 706-NA (Rev. August 2013) Department of the Treasury Internal Revenue Service Estate of nonresident not a citizen of the United States To be filed for decedents dying after December 31, 2011. Information about Form 706-NA and its separate instructions is at www.irs.gov/form706na. United States Estate (and GenerationSkipping Transfer) Tax Return OMB No. 1545-0531 Part I 3 Attach supplemental documents and translations. Show amounts in U.S. dollars. Decedent, Executor, and Attorney b Decedent's last (family) name 5 8 Citizenship (nationality) Business or occupation 2 U.S. taxpayer ID number (if any) 6 Date of death 4 Domicile at time of death b Place of birth 1a Decedent's first (given) name and middle initial Place of death 7a Date of birth 9a Name of executor 10a Name of attorney for estate b Address In United States b Address 11a Name of executor 12a Name of attorney for estate b Address (City or town, state or province, country, and ZIP or foreign postal code.) Outside United States Part II 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 b Address (City or town, state or province, country, and ZIP or foreign postal code.) Tax Computation 1 2 3 4 5 6 7 8 Taxable estate from Schedule B, line 9 . . . . . . . . . . . . . . . . . . . . . Total taxable gifts of tangible or intangible property located in the U.S., transferred (directly or indirectly) by the decedent after December 31, 1976, and not included in the gross estate (see section 2511) . . Total. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . Tentative tax on the amount on line 3 (see instructions) . . . . . . . . . . Tentative tax on the amount on line 2 (see instructions) . . . . . . . . . . Gross estate tax. Subtract line 5 from line 4 . . . . . . . . . . . . . Unified credit. Enter smaller of line 6 amount or maximum allowed (see instructions) Balance. Subtract line 7 from line 6 . . . . . . . . . . . . . . . . Other credits (see instructions) . . . . . . . . . . . . . . . . 9 Credit for tax on prior transfers. Attach Schedule Q, Form 706 . . . . . 10 Total. Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . Net estate tax. Subtract line 11 from line 8 . . . . . . . . . . Total generation-skipping transfer tax. Attach Schedule R, Form 706 . Total transfer taxes. Add lines 12 and 13 . . . . . . . Earlier payments. See instructions and attach explanation . . Balance due. Subtract line 15 from line 14 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 13 14 15 16 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, it is true, correct, and complete. I understand that a complete return requires listing all property constituting the part of the decedent's gross estate (as defined by the statute) situated in the United States. Declaration of preparer other than the executor is based on all information of which preparer has any knowledge. Sign Here Paid Preparer Use Only Signature of executor Signature of executor Preparer's signature Date Date Check if self-employed Firm's EIN Phone no. PTIN Print/Type preparer's name Date Firm's name Firm's address Cat. No. 10145K For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Form 706-NA (Rev. 8-2013) American LegalNet, Inc. www.FormsWorkFlow.com Form 706-NA (Rev. 8-2013) Page 2 Part III General Information Yes No 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 sections 2035, 2036, 2037, or 2038 (see the instructions for Form 706, Schedule G)? . . . . . . . . . If "Yes," attach Schedule G, Form 706. 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. At the date of death, did the decedent: Have a general power of appointment over any property located in the United States? . 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? . 8 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? 9 a 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 to Schedule R of Form 706? . . . . . . If "Yes," attach Schedules R and/or R-1, Form 706. 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. 6a 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) 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