Form Et 85 – Fill Out and Use This PDF

Department of Taxation and Finance

ET-85

For office use only

New York State Estate Tax Certification

(10/19)

For an estate of an individual whose date of death is on or after January 1, 2019

Decedent’s last name

First name

Middle initial

Social Security number (SSN)

Address of decedent at time of death (number and street)

Date of death

Mark an X if

copy of death

certificate is

attached (see instr.)

City

State

ZIP code

County of residence

If the decedent was a nonresident of New York State on the date of death, mark an X in this box and attach a completed

Form ET-141, New York State Estate Tax Domicile Affidavit.

Power of Attorney – Mark an X if Form ET-14, Estate Tax Power of Attorney, is attached

(see instructions)

If Form ET-14 was previously provided, indicate which form it was attached to and the date it was submitted:

Form __________ Date _____________

Executor – If you are submitting Letters Testamentary or Letters of Administration with this form, indicate in this box

the type of letters. Enter L if regular, LL if limited letters. If you are not submitting letters with this form, enter N

Attorney’s or authorized representative’s last name

First name

MI

Executor’s last name

First name

MI

In care of (firm’s name)

If more than one executor,

Email address of executor

mark an X in the box (see instr.)

Address of attorney or authorized representative

Address of executor

City

State

ZIP code

City

State

ZIP code

SSN or PTIN of attorney or authorized rep.

Telephone number

Social Security number of executor

Telephone number

(

)

(

)

If

an attorney or authorized representative is

listed above, he or she must

complete the following declaration.

(mark an X in all boxes that apply):

an attorney

a certified public accountant

an enrolled agent

Estimated net estate (including jointly held assets)

Were releases of lien previously issued?

Yes

No

1

Real property

1

2

Bank deposits, mortgages, notes and cash

2

If Yes, give date of issuance (mm-dd-yyyy).

Stocks and bonds

3

3

Was the decedent a member of a partnership?

Yes

No

4

Life insurance

4

5

Annuities

5

Did the decedent have a surviving spouse?

Yes

No

Retirement benefits

6

6

If the decedent was a nonresident of New York

7

Miscellaneous assets

State, does the estate include real property or

(see instructions)

7

tangible personal property having an actual

8

Taxable gifts (see instructions)

8

situs in New York State?

Yes

No

9

Add lines 1 through 8

9

10

Estimated deductions

10

11

Estimated net estate (subtract line 10 from line 9)

11