arate instructions is at wwwirs.goviforogosi . (Fa gas made Owing calendar year 2012) ► See Instructions. 1 Donor's first name and middle initial BENJAMIN E 4 rtment number) 2 Donor's last name BLACK CVO to 1545.0:O) 2012 3 Ili filial 5 Legal residence (domicile) NEW YORK 7 Citizenship (see instru