| A. ADJUSTED TAX BASIS OF PROPERTY RELINQUISHED | |
| 1. Cost of original property relinquished | $ |
| 2. Accumulated depreciation | $ |
| 3. Adjusted basis of property conveyed (line 1 less line 2) | $ |
| B. REALIZED GAIN | |
| 4. Fair market value of property received | $ |
| 5. Cash received | $ |
| 6. Fair market value of other boot received | $ |
| 7. Mortgage balance on property relinquished | $ |
| 8. Total consideration received (sum of lines 4 through 7) | $ |
| LESS | |
| 9. Adjusted basis of property relinquished (line 3) | $ |
| 10. Cash given | $ |
| 11. Adjusted basis of other boot relinquished | $ |
| 12. Mortgage incurred on property received | $ |
| 13. "Out of pocket" exchange related expenses paid | $ |
| 14. Total consideration given ( sum of line 9 through 13 ) | $ |
| 15. Gain realized on exchange ( line 8 less line 14 ) | $ |
| C. RECOGNIZED GAIN | |
| CASH AND BOOT | |
| 16. Cash and other boot received ( sum of lines 5 and 6 ) | $ |
| 17. Cash and other boot relinquished ( sum of lines 10 and 11 ) | $ |
| 18. Exchange expenses paid ( line13 ) | $ |
| 19. Net cash and other boot received ( line 16 less line 17 and 18 ) or paid , if negative | $ |
| MORTGAGE RELIEF | |
| 20. Mortgage on property relinquished (line 7) | $ |
| 21. Mortgage incurred on property received ( line 12 ) | $ |
| 22. Net Mortgage relief ( line 20 less line 21; if less than zero, enter "0") | $ |
| 23. Gain recognized ( line 19 plus line 22; line 23 cannot exceed line 15; if negative, enter "0") | $ |
| D. ADJUSTED BASIS OF NEW PROPERTY | |
| 24. Adjusted basis of property relinquished ( line 3 ) | $ |
| 25. Cash and other boot conveyed ( line 17 ) | $ |
| 26. Mortgage incurred on property received ( line 12 ) | $ |
| 27. Total ( sum of lines 24 through 26 ) | $ |
| 28. Cash and other boot received ( line 16 ) | $ |
| 29. Mortgage on property relinquished ( line 7 ) | $ |
| 30. Total ( sum of lines 28 and 29 ) | $ |
| 31. Line 27 less line 30 | $ |
| 32. Gain recognized on exchange ( line 23 ) | $ |
| 33. Exchange expenses paid ( line 13 ) | $ |
| 34. Adjusted basis of new property ( sum of lines 31 through 33 ) | $ |