The Form 5000 is the official form of the IRS for estate tax returns. It is used to report the value of an estate and any taxes that are due. The form must be filed within nine months of the date of death, and it can be filed by either the executor or the beneficiary. There are a number of supporting documents that must also be filed with the Form 5000, including a certified copy of the death certificate, a list of assets and liabilities, and a description of how the assets were distributed. Filing the Form 5000 can be complex, so it is important to consult with an attorney or accountant if you have any questions.
| Question | Answer |
|---|---|
| Form Name | Form 5000 En |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | form 5000 france, tax certificate residence, en certificate residence, tax certificate residence online |
For use by the
foreign tax
authority
CERTIFICATE OF RESIDENCE
12816*01
Application for implementation of the tax treaty between France and
NUMBER OF
ATTACHMENTS
Please write the name of the country in this box
I) Types of income
□ Dividends |
□ Normal procedure |
Attach Form 5001 |
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□ Interest |
Attach Form 5002 |
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□ Simplified procedure |
File this certificate |
of |
□ Royalties |
Attach Form 5003 |
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residence only |
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II) Beneficiary |
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Surname and first name, or |
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company name |
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Occupation |
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Full home address |
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or registered office |
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For United States residents |
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See note |
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III) Beneficiary’s declaration
Investment companies and funds please complete box VII as well
I hereby declare that: |
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- I am beneficially entitled to the income for which the treaty benefits are being claimed; |
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- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund |
or |
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an investment company , is established in) …………………...………………………………………………………. |
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- I do not have any establishment or permanent base that this income is attached to in France; |
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- This income has been or will be reported to the tax authorities in my country of residence. |
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………………………………………………... |
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Date and place |
Signature of beneficiary or his/her legal representative |
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IV) Declaration of the foreign tax authority
The tax authority of ……………………………………..………………… hereby certifies that to the best of its knowledge:
- The information provided by the applicant is correct; |
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- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund |
or |
an investment company , is established in) …………………...………………………………………………………. |
; |
-The beneficiary of the income is subject to taxation by the authority under the tax identification number …………….…..
(where applicable).
………………………………………………...
Date and place |
Signature and seal |
V) Declaration of the paying institution
Name
Address
SIREN number
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We hereby declare that we have paid the beneficiary the income referred to in this application, net of the withholding tax at the rate provided for in French domestic law.
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Date and place |
Seal |
VI) Declaration of the US financial institution
(For beneficiaries who are United States residents only)
Name
Address
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The abovenamed institution hereby certifies that, to the best of its knowledge, the applicant is a resident of the United States and that the information provided on this form is correct.
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Date and placeSeal
VII) Investment company or fund |
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- Financial year from………...………… to…………………; |
- Number of unit holders or shareholders in fund: |
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- In the case of German funds, if the French authorities |
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have issued an authorisation: authorisation date and number: |
- Percentage of unit holders or shareholders who are |
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authorisation number ……………… date ………………..…….. |
residents of: |
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% |
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VIII) In case of direct refund by the tax authority
Where should the repayment be sent (bank, post office, account) ?
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To be kept by the beneficiary
CERTIFICATE OF RESIDENCE
12816*01
Application for implementation of the tax treaty between France and
NUMBER OF
ATTACHMENTS
Please write the name of the country in this box
I) Types of income
□ Dividends |
□ Normal procedure |
Attach Form 5001 |
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□ Interest |
Attach Form 5002 |
||
□ Simplified procedure |
File this certificate |
of |
□ Royalties |
Attach Form 5003 |
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residence only |
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II) Beneficiary |
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Surname and first name, or |
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company name |
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Occupation |
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Full home address |
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or registered office |
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For United States residents |
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See note |
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III) Beneficiary’s declaration
Investment companies and funds please complete box VII as well
I hereby declare that: |
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- I am beneficially entitled to the income for which the treaty benefits are being claimed; |
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- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund |
or |
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an investment company , is established in) …………………………………………………………………………… |
; |
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- I do not have any establishment or permanent base that this income is attached to in France; |
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- This income has been or will be reported to the tax authorities in my country of residence. |
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………………………………………………... |
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Date and place |
Signature of beneficiary or his/her legal representative |
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IV) Declaration of the foreign tax authority
The tax authority of ……………………………………..………………… hereby certifies that to the best of its knowledge:
- The information provided by the applicant is correct; |
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- For the purposes of the abovementioned tax treaty, the beneficiary is a resident of (or in the case of pension fund |
or |
an investment company , is established in) …………………...………………………………………………………. |
; |
-The beneficiary of the income is subject to taxation by the authority under the tax identification number …………….…..
(where applicable).
………………………………………………...
Date and place |
Signature and seal |
V) Declaration of the paying institution
Name
Address
SIREN number
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We hereby declare that we have paid the beneficiary the income referred to in this application, net of the withholding tax at the rate provided for in French domestic law.
………………………………………………...
Date and place |
Seal |
VI) Declaration of the US financial institution
(For beneficiaries who are United States residents only)
Name
Address
...........................................................................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
The abovenamed institution hereby certifies that, to the best of its knowledge, the applicant is a resident of the United States and that the information provided on this form is correct.
………………………………………………...
Date and placeSeal
VII) Investment company or fund |
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- Financial year from………...………… to…………………; |
- Number of unit holders or shareholders in fund: |
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- In the case of German funds, if the French authorities |
...................................………………………… |
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have issued an authorisation: authorisation date and number: |
- Percentage of unit holders or shareholders who are |
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authorisation number ……………… date ………………..…….. |
residents of: |
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% |
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VIII) In case of direct refund by the tax authority
Where should the repayment be sent (bank, post office, account) ?
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For use by the
French tax
authority
ATTESTATION DE RESIDENCE
12816*01
Demande d’application de la convention fiscale entre la France et
NOMBRE D’ANNEXES
Inscrire dans cette case le nom de l’Etat contractant
I) Nature des revenus
□
□ Dividendes |
□ |
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Procédure normale |
Joindre |
un formulaire |
□ Intérêts |
Joindre un formulaire |
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annexe n° 5001 |
□ Redevances |
annexe n° 5002 |
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Procédure simplifiée |
File this |
certificate of |
Joindre un formulaire |
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residence only |
annexe n° 5003 |
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II) Désignation du bénéficiaire des revenus
Nom et prénom ou raison sociale |
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Profession |
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Adresse complète du domicile |
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ou du siège social |
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Pour les résidents des |
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cf. notice |
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III) Déclaration du bénéficiaire des revenus |
Fonds et sociétés d’investissement : compléter aussi le cadre VII |
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Le soussigné certifie : |
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être le bénéficiaire effectif des revenus pour lesquels le bénéfice de la convention est demandé ; |
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avoir, au sens de la convention fiscale susvisée, la qualité de résident de (ou s’agissant d’un fonds de pension ou d’un |
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fonds ou d’ une société d’investissement être établi à) …………………………………………...………………….. |
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- ne pas posséder en France d’établissement ou de base fixe auxquels se rattachent les revenus ; |
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- que ces revenus ont été ou seront déclarés à l’administration des impôts de l’Etat de résidence. |
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………………………………………………... |
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Date et lieu |
Signature du bénéficiaire ou de son représentant légal |
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IV) Déclaration de l’administration étrangère
L’administration fiscale de ……………………………………………………..……………. certifie qu’à sa connaissance :
-les indications portées par le déclarant sur la présente demande sont exactes ;
-au sens de la convention fiscale susvisée le bénéficiaire a bien la qualité de résident de (ou s’agissant d’un fonds de
pension ou d’un fonds ou d’une société d’investissement être établi à) …………………………...……...……. ;
-le bénéficiaire des revenus relève de son ressort sous le numéro fiscal …………………...…………………………….…..
(si un tel numéro existe).
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Date et lieu |
Signature et tampon |
V) Déclaration de l’établissement payeur
Nom / Dénomination
Adresse
Numéro SIREN
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Nous certifions avoir payé au bénéficiaire les revenus compris dans la présente demande pour leur montant net c’est à dire déduction faite de l’impôt à la source au taux prévu par le droit interne français.
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Date et lieu |
Cachet |
VI) Déclaration de l’établissement financier américain
(pour les seuls bénéficiaires résidents des
Nom / Dénomination
Adresse
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L’établissement désigné
………………………………………………...
Date et lieuCachet
VII) Société ou fonds d’investissement |
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- Exercice social du ………...………… au …………………; |
- Nombre de porteurs de parts du fonds : |
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- Pour les OPCVM d’Allemagne, si l’administration française |
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a délivré une autorisation : date et numéro de l’autorisation : |
- Pourcentage de porteurs de parts résidents de |
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autorisation n° …………………….. du ……………………… |
....................................................... : |
% |
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VIII) En cas de remboursement direct par l’administration au créancier
Où le montant à rembourser
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