Gift Income Tax Form

Gift Income Tax Form

Form Date:

WHEREAS

WHEREAS, Donor Name: , Taxpayer Identification Number: , has transferred a gift as described below;

WHEREAS, Recipient Name: , Taxpayer Identification Number: , reports receipt of said gift for the reporting period ending: .

Gift Details

Date of Gift:

Cash Property Services Other:

Donor Filing Information

Donor filed a gift tax return (Form 709 or equivalent): Yes No

If yes, Return Filed Date:

Income Considerations

Was any portion of the gift reported as income by the recipient? Yes No

Use and Disclosure; Certification

The information contained in this form is provided for the purpose of determining tax reporting obligations. The recipient certifies that the information is true, correct and complete to the best of the recipient's knowledge and authorizes disclosure to tax authorities where required by law. Confidential taxpayer information will be handled in accordance with applicable confidentiality laws governing tax information.

Certification: Under penalty of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, the facts presented herein are true, correct and complete. I understand that gifts are generally not includible in gross income of the recipient under income tax law, but certain conditions or benefits received in connection with a transfer may have tax consequences and may require reporting. I further acknowledge that responsibility for donor gift tax reporting rests with the donor unless otherwise provided by law.

Additional Notes

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