Exhibit 3.11.106-4 - Form 709, Page 1Summary: This is an example of a Form 709, United States Gift (and Generation-Skipping Transfer) Tax Return, with transcription lines. The following items are transcribed:CCCTax PeriodUnder Part 1 - General Information:2. Donor's last name3. Donor's social security number4. Address (number, street, and apartment number)7. CitizenshipDeceased Donor Code10. Enter the total number of donees listed on Schedule A14. Spouse's SSNConsent CodeUnder Part 2 - Tax Computation:1. Enter the amount from Schedule A, Part 4, line 112. Enter the amount from Schedule B, line 33. Total taxable gifts (add lines 1 and 2)4. Tax computed on amount on line 3 (see table for computing tax in separate instructions)5. Tax computed on amount on line 2 (see table for computing tax in separate instructions)6. Balance (subtract line 5 from line 4)7. Maximum unified/applicable credit (nonresident aliens) (received date)8. Enter the unified/applicable credit against tax allowable for all prior periods (from Schedule B, line 1, column C)9. Balance (subtract line 8 from line 7)10. Enter 20% of the amount allowed as a specific exemption for gifts made after September 8, 1976, and before January 1, 197711. Balance (subtract line 10 from line 9)12. Unified/Applicable credit (enter the smaller of line 6 or line 11)13. Credit for foreign gift taxes14. Total credits (add lines 12 and 13)15. Balance (subtract line 14 from line 6) (do not enter less than zero)16. This line has been marked as reserved for 2010 as the GST tax has been repealed for one year.17. Total tax (add lines 15 and 16) (dollars and cents field)18. Gift taxes prepaid with extension of time to file (dollars and cents field)19. If line 18 is less than line 17, enter balance due (Remittance) (dollars and cents field)20. If line 18 is greater than line 17, enter amount to be refunded (dollars and cents field)Action Code