Form 92A201 – Fill Out and Use This PDF

This return may be used if: (1) there is no Kentucky inheritance tax due, (2) the date of death is on or after January 1, 2005, and

(3)the entire estate passes to beneficiaries listed in the following groups either by contract (survivorship, payable on death, trust, etc.), the decedent’s will, or the intestate laws of this state:

(1)Surviving spouse, parent

(2)Child (adult or infant)

child by blood, stepchild, child adopted during infancy,

or a child adopted during adulthood who was reared by decedent during infancy

(3)Grandchild

issue of child by blood, stepchild, child adopted during infancy,

or of a child adopted during adulthood who was reared by decedent during infancy

(4)Brother, sister (whole or half)

➤Refer to KRS 140.080 for (1) through (4) above

(5)Exempt organizations—Refer to KRS 140.060

Exempt organizations include educational, religious or other institutions, societies, or associations, whose sole purpose is to carry on charitable, educational, or religious work. Also, cities, towns or public institutions in this state qualify as exempt organizations provided that any transfer to such an organization is for public purposes.

Decedent’s Name Last	First		Middle Initial	Date of Death
Social Security Number	Occupation (If decedent was retired	Age at Death	Cause of Death	HR Code Number (if known)
	at death, state occupation prior to
	retirement.)

Residence (Domicile) at Time of Death

	Number and Street	City		State	ZIP Code	County
Name and Address of Executor/Administrator/Beneficiary			Name and Address of Preparer
 Exec			 Atty
 Admr			 CPA
 ________			 ________

Did the decedent have a will?  No  Yes If Yes, attach a copy of the will.

Did the decedent have a trust agreement?  No		 Yes If Yes, attach a copy of the trust agreement.
Filing status of Federal Estate and Gift Tax Return for this estate (check one):
 Not Required	 Required (enclose copy)	 Not Required, but filed for Portability (enclose copy)

Schedules for listing property (real and personal) and beneficiaries are on the reverse side of this form. Listing of property is optional. Listing of beneficiaries and their relationship is required.

Total Value of Property from Reverse Side						(optional) ➤ $
✍ Under criminal penalties, I declare that this return, including accompanying						documents, has been examined by me, and
is, to the best of my knowledge and belief, true, correct and complete.
				 (	)
Signature of Executor/Administrator/Beneficiary		Date		Telephone Number					E-mail Address
				 (	)
Signature of Preparer		Date		Telephone Number					E-mail Address

Mail to: Kentucky Department of Revenue, Frankfort, Kentucky 40620

92A201 (6-16)

PART I—PROPERTY (Optional Listing)

If all taxable assets pass to exempt beneficiaries and a Federal Estate and Gift Tax Return is not filed, it is not necessary to file an Inheritance Tax Return with the Kentucky Department of Revenue. An affidavit of exemption will be accepted by the courts for the final settlement and closing of the administration of an estate. If inheritance tax is due the Commonwealth of Kentucky, Form 92A200 or 92A205 should be used.