Form 13925 Notice of Election of and Agreement To Special Lien Unde

Department of the Treasury — Internal Revenue Service
Form

13925

(November 2007)

Notice of Election of and Agreement To Special Lien
in Accordance With Internal Revenue Code Section 6324A and
Related Regulations

OMB No. XXXX-XXXX

Decedent’s Name

Social Security Number

Date of Death

Amount of Lien:
A. Amount of deferred federal estate taxes

$

B. Interest over first four years of deferral period

$

TOTAL: $

Fair Market Value of the Property Subject to the Lien:
A. As of the date of death of the decedent

$

B. As of the date this document is executed

$

(attach evidence of current value)

Amount of any Encumbrances on the Property,
Including Mortgages, Judgments, Other Tax Liens,
IRC section 6324B Liens, etc.
A. As of the date of death of the decedent

$

B. As of the date this document is executed

$

(attach evidence of current value)

Attach to this document a complete legal description of the property, as shown
on the deed, which is subject to the lien. If the subject property is not land,
include a clear description and statement of the estimated remaining useful life.
By signing this agreement, we agree to provide to the IRS current valuation information
annually with respect to the pledged property listed in this agreement within 60 days
of the end of the fiscal (in the case of a closely held business) or calendar year.

Catalog Number 50980J

www.irs.gov

Form

13925 (11-2007)

The agent designated by the undersigned to represent them and all beneficiaries of the estate for all
dealings with the Internal Revenue Service on matters arising under section 6324A or section 6166 is:
Name:
Street:
City, State and Zip Code:
Telephone Number:
Fax Number:

PLEASE ATTACH COPIES OF THE POWER(S) OF ATTORNEY
The undersigned, being all of the persons in being having an interest in the designated property
(whether or not in possession), hereby consent to the creation of this lien on the property under
section 6324A of the Internal Revenue Code.

Signature/Date

Print Name

Signature/Date

Print Name

Signature/Date

Print Name

Signature/Date

Print Name

Signature/Date

Print Name

Signature/Date

Print Name

Privacy Act and Paperwork Reduction Act Notice
We ask for the information on this form to carry out the Internal Revenue laws of the United States. To the extent you elect to defer payment of estate tax
under Internal Revenue Code section 6166, we have determined that you are required to provide a bond in favor of the United States as security for that
election. In lieu of a bond, you may elect to provide a lien under section 6324A. You are not required to elect to provide a lien as security for the deferral of
payment of estate taxes. However, if you do make such an election you are required to provide the information requested on this form. We collect this
information under the authority of Internal Revenue Code Section 6324A. This information is necessary to ensure that you are complying with these laws and
to allow us to figure and collect the right amount of tax. Failure to provide the information may delay or prevent processing your request and may ultimately
result in a denial of your election to defer estate tax under Internal Revenue Code Section 6166. Under section 6109, you must disclose the decedent’s SSN.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration
of any Internal Revenue law. Generally, tax returns and return information are confidential as required by section 6103. However, section 6103 allows or
requires the Internal Revenue Service to disclose or give such information shown on your Form 13925 to others as described in the Code. For example,
routine uses of this information include giving it to the Department of Justice to enforce the tax laws, both civil and criminal, and to cities, states, the District of
Columbia, and U.S. commonwealths or possessions for use in administering their tax laws. We may also disclose this information to other countries under a
tax treaty, to federal and states agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
The time needed to complete and file this form and related schedules will vary depending on individual circumstances. The estimated average times are:
Recordkeeping xxhr., xx min.
Learning about the law or the form xxhr., xx min.
Preparing the form xxhr., xx min.
Copying, assembling, and sending
The form to the IRS xxhr., xx min.
If you have any comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from
you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6404,
Washington, DC 20224. Do not sent the tax form to this address.

Catalog Number 50980J

www.irs.gov

Form

13925 (11-2007)