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E Service Expires 5-31-96 Calendar year 19 1 Donor s first name and middle initial 2 Donor s last name 3 Donor s social security number 4 Address (number, street, and apartment number) 5 Legal residence (domicile) 6 City, state, and ZIP code 7 Citizenship 8 Did you file any gift tax returns for prior periods? If Yes, state when and where earlier returns were filed 9 Name of consenting spouse Yes No 10 Consenting spouse s social security number Note: Do not use th.

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