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
SharesBasis per Share
as of [date]X Company ________ $ Y Company ________ $
____________________________________
(Name of distributee or beneficiary)____________________________________
(Address)
Executed this _____ day of ___________, 19__.
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