Fonn 709 Department of the Treesay Omens, Revenue Service United States Gift (and Generation-Skipping Transfer) Tax Return IP. Information about Form 709 and its separate instructions is at wwwirs.goviforogog . Pr aim made dump calendar year 2012) In. See Instructions. CVO to 1545.0:O) 2012 1 Donor's first name and middle initial BENJAMIN E 4 Address number. street. and a artment number) 2 Donor's last name BLACK 3 Donor's social security number 5 Legal residence (domicile) NEW YORK 7 Citizenship (see instructions) UNITED STATES 6 City, state, and ZIP or postal code NEW YORK, NY 10021 8 If the donor died during the year, check here Illb• L_I and enter date of death 9 If you extended the time to file this Form 709, check here la. L 10 Enter the total number of donees listed on Schedule A. Count each person only once. la. 1 11a Have you (the donor) previously filed a Form 709 (or 709-A) for any other year? If 'No," skip line 11b b Has your address changed since you last filed Form 709 (or 709-A)? 12 Gifts by husband or wife to third parties. Do you consent to have the gifts (including generation-skipping transfers) made by you and by your spouse to third parties during the calendar year considered as made one-half by each of you? (see instructions.) (If the answer is "Yes; the following information must be furnished and your spouse must sign the consent shown below. If the answer is 'No,' skip lines 13-18.) 13 Name of consenting spouse 1 14 SSN 15 Were you married to one another during the entire calendar year? (see instructions) 16 17 Will a gift tax return for this year be filed by your spouse? (If 'Yes,' mail both returns in the same envelope.) 18 Yes No X X If 15 is 'No,' check whether L_I married L_I divorced or LJ widowed/deceased, and give date ► Consent of Spouse. I consent to have the gifts (and generation-skipping transfers) made by me and by my spouse to third parties d ring the calendar year considered as m