Form C 3 Uge PDF Details

In the wake of a loved one's passing, navigating the maze of legal and financial obligations can often become overwhelming for the bereaved. Among these responsibilities, handling estate taxes becomes paramount, especially in states like Connecticut which require specific documentation for estates of decedents. Introduced for estates of individuals passing on or after January 1, 2005, the Department of Revenue Services Form C-3 UGE, also known as the State of Connecticut Domicile Declaration, serves as a critical document in such instances. This form is specifically designed to ascertain the decedent's residency status for estate tax purposes. It is a thorough document, requiring detailed information about the decedent's domicile, real estate holdings, voting registration, tax payments, and even details about social memberships and healthcare over the five years preceding death. Providing a clear snapshot of the decedent's ties to Connecticut or lack thereof, the form’s completeness plays a pivotal role in the appropriate categorization of the estate, impacting how it will be taxed. It is crucial for fiduciaries to diligently fill out the C-3 UGE, include additional statements as necessary, and keep abreast of the nuances that might affect the estate's tax obligations to the State of Connecticut.

QuestionAnswer
Form NameForm C 3 Uge
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesuge department revenue, ct state declaration, form connecticut c3, connecticut state uge

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Department of Revenue Services

Form C-3 UGE

 

 

 

 

 

 

Estate Tax Section

 

 

 

 

 

 

State of Connecticut Domicile Declaration

 

 

 

 

 

PO Box 2972

 

 

 

 

 

Hartford CT 06104-2972

To be used by estates of decedents dying on or after January 1, 2005

 

 

 

 

(Rev. 05/11)

 

 

 

 

 

 

 

 

 

 

 

 

Decedent’s last name

First name and middle initial

 

Social Security Number (SSN)

 

 

 

 

 

•

 

•

 

 

 

 

 

__ __ __

•

__ __

•

__ __ __

 

 

 

 

•

•

 

 

 

 

 

•

 

•

 

Decedent’s residence on date of death (number and street, apartment number)

 

Age at death

Date of death

 

 

 

 

 

 

 

 

 

 

 

City, town, or post offi ce

State

ZIP code

Year domicile

Connecticut Probate Court

 

 

 

 

 

established

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General Instructions: Generally, whenever a decedent is claimed to be a nonresident of Connecticut, the fiduciary of the decedent’s estate must file Form C-3 UGE, STATE OF CONNECTICUT DOMICILE DECLARATION. All questions must be answered fully for the declaration to be considered complete. For the estate of a decedent dying on or after January 1, 2005, Form C-3 UGE must be filed with the Department of Revenue Services (DRS) if the decedent’s Connecticut taxable estate as valued for federal estate tax purposes exceeds the Connecticut estate tax exemption amount for the year of death and must be filed with the appropriate Connecticut Probate Court if the decedent’s Connecticut taxable estate is equal to or less than the Connecticut estate tax exemption amount for the year of death. Complete this form in blue or black ink only. Attach additional statements as needed.

1.

What is your relationship to the decedent?_______________________________________________________________________

2.

Did the decedent ever live in Connecticut? Yes No

If Yes, list periods: ______________________________________

3.

Did the decedent live part of the year in Connecticut and part of the year outside of Connecticut?

Yes No

 

If Yes, list periods:__________________________________________________________________________________________

4.Identify and list the address of each piece of real estate owned by the decedent, the decedent’s spouse, or both, or a trust for the five years preceding death. Indicate whether the decedent lived in a house that was rented or owned, apartment, condominium, cooperative, hotel, nursing home, or in the home of relatives or friends. State the assessed and fair market value of real estate owned by the decedent, the decedent’s spouse, or both, or a trust in the year of death.

Date

(From - To)

Address/Town

Owned State or Rented

Description

Assessed

Value

Fair Market

Value

Part Full Year Year

5.List the states where the decedent was registered to vote during each of the five years preceding death and attach copies of voter registration cards. List the latest year first. ______________________________________________________________________

6.Identify in which state(s) or political subdivisions of state(s) the decedent filed income tax, property tax, or intangible tax returns and the taxes paid during the five years preceding death. Include the year(s) for which the returns were filed or tax paid. If an income tax return was fi led, note whether it was a resident or nonresident return.

Tax Year(s)

State or Political Subdivision

Tax Type

Tax Paid

Resident or Nonresident

7.Did the decedent fi le federal income tax returns?Yes No

If Yes, what was the decedent’s address on the returns? ___________________________________________________________

8. Was the decedent employed or engaged in a business or profession in the fi ve years preceding death? Yes No

If Yes, list the employment or business activities engaged in by the decedent during the fi ve years preceding the date of death.

 

In Connecticut

 

Outside Connecticut

 

 

 

 

Period of Time

 

Period of Time

 

(From - To)

Nature of Employment or Business Activities

(From - To)

Nature of Employment or Business Activities

 

 

 

 

 

 

 

 

 

 

 

 

9.Did the decedent execute a will, codicil, trust indenture, deed, mortgage, lease, or any other document in the five years preceding death?

Yes No

If Yes, give the dates and facts and attach copies of all documents. _______________________________

10. Was the decedent a party to any legal proceedings in the State of Connecticut during the fi ve years preceding death?

Yes NoIf Yes, explain fully and submit copies of the court documents fi led by or for the decedent. ______________

_______________________________________________________________________________________________________

11. Did the decedent hold membership in any religious organizations, clubs, or societies in Connecticut in the five years preceding death?

Yes No

If Yes, detail the facts. ___________________________________________________________________

12.Did the decedent hold membership in any religious organizations, clubs, or societies outside Connecticut in the five years preceding death?

 

Yes No

If Yes, detail the facts. ___________________________________________________________________

13.

Did the decedent lease a safe deposit box located in Connecticut at the time of death? Yes No

 

If Yes, has it been inventoried? Yes NoIf Yes, attach copy of inventory.

 

Name and address of bank where box is located: ________________________________________________________________

 

_______________________________________________________________________________________________________

14.

Did the decedent have a license in Connecticut or elsewhere to operate a business, profession, motor vehicle, airplane, or

 

boat at any time within five years preceding death? Yes No  If Yes, list below and attach copies of the license(s).

License Number

Type of License

Date of Issuance

Name and Location of Issuing Office

15. Was an automobile registered in the decedent’s name in Connecticut or elsewhere at any time within five years preceding death?

Yes No

If Yes, where and when (that is, the dates of registrations)? ______________________________________

16. Was the decedent hospitalized in Connecticut at any time within fi ve years preceding death?

Yes No

If Yes, furnish name and address of the hospital(s) and the dates of hospitalization(s). ___________________________________

17.Did the decedent undergo medical treatment or examination in Connecticut at any time within the five years preceding death?

Yes No If Yes, furnish name and address of the doctor or hospital and the dates of treatment(s) or examination(s).

_______________________________________________________________________________________________________

18.Provide the place of the decedent’s death and burial. Attach copies of the decedent’s death certificate and obituaries in the newspapers in Connecticut and elsewhere. _______________________________________________________________________________

Form C-3 UGE (Rev. 05/11)

Page 2 of 3

19.Name and address of the bank to which decedent’s social security payments were deposited during each of the five years preceding death. __________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

20. Did the decedent execute and file a DECLARATION OF DOMICILE in another jurisdiction?Yes No If Yes, attach a copy.

21.If the decedent was at one time a resident of Connecticut, what event(s) or action(s) changed the decedent’s status to nonresident?

________________________________________________________ On what date did this occur? ______________________

22.What additional information do you wish to submit in support of the contention that the decedent was not domiciled in Connecticut at the time of death? Attach additional sheets if necessary. ___________________________________________________________

_______________________________________________________________________________________________________

23.Enter the number of days the decedent actually stayed in Connecticut and in the state where domicile is claimed for each of the five years preceding death. The estate may be asked to provide more details to support the information provided.

Year

Days in Connecticut

Days in State Where Decedent’s Domicile Is Claimed

24. List the name, address, and relationship of all family members of the decedent with whom he or she had the closest familial relationship.

Name

Address

Relationship

25.Estimate the total value of the gross estate, less deductions, for federal estate tax purposes. Be sure to add to that figure the Connecticut taxable gifts made by the decedent during all calendar years beginning on or after January 1, 2005: $ ___________________________

26.Signature and declaration

Attorney or authorized representative’s name

Date

Telephone number

()

Law firm name

Address

City

State

ZIP code

Declaration for DRS: I declare under penalty of law that I have examined this document (including any accompanying schedules and statements) and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false document to DRS is a fine of not more than $5,000, imprisonment for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.

Declaration for Probate Court: I declare under penalty of false statement under Conn. Gen. Stat. §§53a-157b that I have examined this document (including any accompanying schedules and statements) and, to the best of my knowledge and belief, it is true, complete, and correct. The declaration of a paid preparer other than the fi duciary is based on all information of which the preparer has any knowledge

Sign Here

Keep a copy of this return for your records.

Fiduciary’s name

 

 

Telephone number

 

 

 

(

)

 

 

 

 

 

Address

City

State

ZIP code

 

 

 

 

Fiduciary’s signature

 

Date of fiduciary’s signature

 

 

 

 

 

 

Official Determination

Use

Only

Signed

Form C-3 UGE (Rev. 05/11)

Page 3 of 3

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With regards to the fields of this precise form, here's what you need to know:

1. To begin with, once filling out the c declaration c3 form, start with the area that has the subsequent fields:

Stage # 1 in filling in uge department revenue

2. After finishing the last step, go to the subsequent step and fill out all required details in these blanks - From To, AddressTown, State, or Rented, Description, Value, Value, Part Full Year Year, List the states where the, registration cards List the latest, Identify in which states or, Tax Years, State or Political Subdivision, Tax Type, and Tax Paid.

Filling out segment 2 of uge department revenue

3. In this stage, take a look at Was the decedent employed or, In Connecticut, Outside Connecticut, Period of Time, From To, Nature of Employment or Business, Period of Time, From To, Nature of Employment or Business, Did the decedent execute a will, If Yes give the dates and facts, Was the decedent a party to any, and Did the decedent hold membership. Every one of these have to be filled out with greatest accuracy.

Nature of Employment or Business, Was the decedent a party to any, and Nature of Employment or Business in uge department revenue

4. This fourth section comes next with the following blanks to look at: Did the decedent hold membership, If Yes detail the facts, Did the decedent hold membership, death, Yes No, If Yes detail the facts, Did the decedent lease a safe, If Yes has it been inventoried, Did the decedent have a license, License Number, Type of License, Date of Issuance, and Name and Location of Issuing Offi ce.

Type of License, Yes No, and License Number inside uge department revenue

5. This very last step to conclude this document is pivotal. Make certain you fill in the required fields, and this includes Was an automobile registered in, If Yes where and when that is the, Was the decedent hospitalized in, If Yes furnish name and address of, Did the decedent undergo medical, If Yes furnish name and address of, Provide the place of the, in Connecticut and elsewhere, Form C UGE Rev, and Page of, prior to finalizing. Neglecting to accomplish that can end up in a flawed and probably unacceptable form!

If Yes furnish name and address of, in Connecticut and elsewhere, and If Yes where and when that is the inside uge department revenue

Be very attentive while filling in If Yes furnish name and address of and in Connecticut and elsewhere, as this is the section where most people make errors.

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