Ex. S

SAMPLE COLLATERAL AGREEMENT RE BASIS

In consideration of the settlement of the case entitled Estate of [name], Deceased v. United States, Civil No. , I, [name of distributee or beneficiary], do hereby agree that, for all federal tax purposes, my basis in the shares of stock described below, which are included in the decedent's gross estate, shall be [as of the date of death of      [name]     ] [as of the alternate valuation date] as follows:

Name No. and
Class of
Shares
Basis per Share
as of [date]
X Company________ $
Y Company________$


   
____________________________________
(Name of distributee or beneficiary)
 
   
____________________________________
(Address)

Executed this _____ day of ___________, 19__.


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