Form Tt 141A PDF Details

In navigating the complexities of estate taxes, particularly for individuals with ties to New York but who may not have been residents at their time of death, the TT-141A form emerges as a pivotal document. Crafted by the New York State Department of Taxation and Finance, this Estate Tax Domicile Affidavit serves the estates of those who passed away between December 31, 1982, and May 26, 1990. Its primary function is to assert that the deceased was not a resident of New York State at their time of death, a claim that necessitates comprehensive information provided by a fiduciary, surviving spouse, or immediate family member. The form intricately details personal, occupational, and residential histories, alongside affiliations with organizations, voting practices, and the presence of wills or other testamentary documents. Unique to this form is its inclusion of the decedent's property interests, both within and outside New York State, and any related transactions preceding the death that could influence the estate’s tax obligations. Designed to accompany certain other estate tax forms under specified conditions, the TT-141A plays a critical role in estate planning and tax compliance, underscoring its significance in the meticulous process of determining domicile and ultimately facilitating the appropriate administration of an estate’s tax liabilities.

QuestionAnswer
Form NameForm Tt 141A
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namestt141a_103 tt 141a form

Form Preview Example

New York State Department of Taxation and Finance

TT-141A

Estate Tax Domicile Affidavit

(1/03)

For the estate of an individual who died after December 31, 1982, and before May 26, 1990

If it is claimed that the decedent was not a New York State resident at the time of death, the fiduciary (executor or administrator), the surviving spouse, or a member of the decedent’s immediate family, who can provide all the information requested below, should complete this affidavit.

Note – If this affidavit is filed with New York State Form TT-86.5, omit questions 28 through 33.

If the estate is filing Form TT-385, New York State Estate Tax Return, or the date of death is on or after May 26, 1990, use Form ET-141, New York State Estate Tax Domicile Affidavit, instead.

If the estate filed a federal estate tax return, Form 706 or 706-NA, attach a copy. Answer all questions completely.

This affidavit must be notarized on page 4.

Decedent’s last name

 

 

 

 

First name

 

 

 

 

 

 

Initial

 

 

Age at

Date of death (attach

Decedent’s social security number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

death

death certificate)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Decedent’s domicile

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

 

State

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney for estate (if any)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Applicant’s name

 

 

 

 

 

 

 

 

 

 

 

 

2 Applicant’s address and telephone number

 

 

 

3

 

Applicant’s relationship to decedent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or connection with estate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Decedent’s date of birth

5

Decedent’s place of birth

 

 

 

 

 

 

 

5a If born outside the U.S., was decedent a naturalized citizen of the United States?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5b

 

If 5a is Yes, give court and location where naturalized

 

6

 

 

If decedent was a U.S. Citizen, did he or she ever apply for a passport? If Yes, give dates of application and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

renewals and decedent’s address as it appears on the passport.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 Decedent’s occupation (if retired, so state and give former

 

 

8 Name and address of employer (if retired, former employer)

 

 

 

 

 

 

 

 

 

 

occupation)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

Was decedent ever married?

9a If Yes, give date and place of marriage

 

 

10

Name and address of spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Yes, give name, address, and other details. (attach separate sheet if necessary)

11 Was decedent a member of any church, club, or organization?

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12

 

Did decedent leave a will?

13 Name and address of executor or administrator of decedent’s estate (attach copy of certificate of appointment).

 

 

 

 

 

 

Yes

 

 

No

 

If no fiduciary appointed, write none.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if Yes, attach copy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14 Name and address of court where will was or is to be probated, or estate administered

15 Did decedent execute any other wills during

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the last five years preceding death?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

No

(if Yes, attach copy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

Did decedent ever live in New York State?

16a

If Yes, for what periods?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17 Provide the following information regarding the residence(s) of the decedent during the last five years preceding death:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In New York State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Outside New York State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residence

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residence

Period of time

 

 

 

 

 

 

 

 

 

 

 

 

 

owned - rented

 

Period of time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

owned - rented

 

from – to

 

 

 

 

Address

 

 

 

 

 

 

other (explain)

 

 

from - to

 

 

 

 

 

 

 

Address

 

 

 

 

 

other (explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2 of 4 TT-141A (1/03)

18

Did decedent ever own real estate located in

 

 

18a Period of time

18b Address of property

 

 

 

 

 

New York State?

 

 

 

 

 

 

 

 

 

from - to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If Yes, complete items 18(a) and (b))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19

In what state(s) did decedent vote or register to vote during the five years preceding death? (show latest year first)

 

 

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20

If decedent did not vote in those five years, where did he last vote?

 

 

 

 

 

 

 

 

20a When did decedent last vote?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

Did decedent execute any trust indentures, deeds, mortgages, leases, or any other documents describing his residence during the last five years preceding death?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If so, attach copy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22

Did decedent own a safe deposit box

22a

If Yes, has it been inventoried?

 

22b Name and address of bank where box is located.

 

located in New York State?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Yes, attach a copy

 

 

 

 

 

 

 

 

 

 

 

 

 

23

Was decedent a party to any legal proceedings in the state of New York during the last five years of his or her life?

 

If Yes, list the court or tribunal, or other forum, and the date, and type of action.

 

 

 

 

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24

Did decedent have licenses to operate a business, practice a profession, or operate a motor vehicle, airplane, or boat?

 

If Yes, give information requested below.

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License number

 

 

 

 

 

Type of license

 

 

Date of issuance

 

Name and location of issuing office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25

List the Internal Revenue Service Center, and the state, county, and municipality where decedent filed income tax returns and paid tax on income or

 

intangible personal property for the last five years preceding death. (Income tax returns (federal and state) may be required.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

 

 

 

 

Internal Revenue Service Center

 

 

 

 

 

State, county, or municipality

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26

Give detailed information about business activities (if any) engaged in by the decedent during the five years preceding date of death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In New York State

 

 

 

 

 

 

 

 

 

Outside New York State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates

 

 

 

Nature of business activities

 

 

 

Dates

 

 

Nature of business activities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TT-141A (1/03) Page 3 of 4

27What other information do you wish to submit in support of the contention that the decedent was not domiciled in the state of New York at the time of death?

28List below, at total value, any real property, tangible personal property, or intangible personal property wherever located in which the decedent had an interest at death, and taxable transfers made by the decedent within three years of decedent’s death (included in federal gross estate).

(amounts should be taken from federal Form 706)

Real property

$

Tangible personal property

$

Intangible personal property

$

Transfers within three years of death

$

Gift tax paid on gifts made after

$

6/30/78 and within three years of death

 

Total $

29 Did the decedent at time of death own, individually or jointly, any interest in real property in New York State?

Yes

No

If Yes, and Release of Lien is desired, please supply the following information:

 

(complete question 30 also)

Book of Deeds or Liber No.

 

 

 

at page no.

 

 

map no.

 

 

section no.

 

block no.

 

lot no.

 

 

 

 

 

 

Property address

 

 

 

 

 

 

 

 

 

 

 

 

 

Street or road

 

 

 

 

 

City, town, or village

 

30Show assessed and market value (and balance owed on mortgage, if any), of real property described in question 29. (real estate appraisal may be required)

(a) Assessed value - $

 

(b) Market value - $

 

(c) Balance owed on mortgage, if any - $

 

 

 

 

(submit proof of indebtedness)

31Did decedent own any tangible personal property, such as household furnishings, jewelry, coin collections, paintings, boats, automobiles, etc., having an actual situs in New York State?

Yes

No

If Yes, describe in detail.

Item

Address where item is located

Market value

$

$

$

32List below the securities, bank accounts, or other intangible property for which tax waivers are requested.

Name of bank; name of corporation or association issuing stocks and bonds; name of government issuing government bonds; name of insurance company

Amount of account; number of shares of stock; face value of bonds; amount of policy or annuity

Description of stocks or bonds; series of government bonds; kind of policy or annuity

Name(s) on bank account; name(s) on stocks or bonds; name and address of beneficiary or annuitant

(attach additional sheets, if necessary)

Page 4 of 4 TT-141A (1/03)

Complete items 33, 34, and 35 only if decedent owned real or tangible personal property having an actual situs in New York State. (Affirmation section must be completed.)

33 Computation of New York gross estate and taxable estate

 

 

 

 

35 Computation of nonresident tax

 

 

 

 

(a) Federal gross estate*

 

 

 

 

 

 

 

 

Items 30(b) + 31

× Item 34(f) = New York State

 

 

 

 

 

 

 

 

 

 

Item 33(c)

 

 

 

 

 

 

 

 

 

 

 

 

nonresident tax

(b) Less real + tangible personal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

property located outside NYS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(complete Schedule I below)

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(c) New York State gross estate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule I — Real and/or tangible personal property located outside

 

 

 

 

 

 

 

(d) Less:

Funeral expense

 

 

 

 

 

 

 

New York State. (Do not include bank accounts, stocks, bonds, etc.) (Complete this

 

 

 

 

 

 

 

schedule if item 33, line (b), is used.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mortgage (amount entered

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in item 30(c)**)

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

 

 

(e) New York adjusted gross estate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(f) Less:

New York marital deduction**

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New York charitable bequests**

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g) New York taxable estate (enter in item 34(a))

 

 

 

 

 

 

 

 

 

 

 

* A copy of federal Form 706 may be required.

 

 

 

 

 

 

 

 

 

 

 

** if applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: If additional adjustments to federal gross estate are necessary, e.g.,

34 Tax computation as if a resident

 

 

 

 

 

 

 

 

 

 

 

 

 

 

gifts made prior to 1983 or qualified terminable interest property included in

 

 

 

 

 

 

 

 

 

(a) New York taxable estate (from item 33(g))

 

 

 

 

 

 

 

line 33(a), attach separate sheet showing such adjustments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule II — Bequests, etc. to surviving spouse (complete this schedule if a

(b) Plus adjusted New York taxable gifts

 

 

 

 

 

 

 

+

 

 

 

 

 

 

marital deduction is claimed in item 33 line (f)) If entire estate passes to surviving

made after 1982

 

 

 

 

 

 

spouse, write entire estate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(c) New York tentative estate tax base

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(d) New York tentative estate tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(compute on amount shown on line (c); see Table A)

 

 

 

 

 

 

 

 

 

 

 

(e) Less: Unified credit (see Table B)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New York gift tax payable on

+

 

 

 

 

 

 

 

 

 

 

 

 

 

 

amount shown on line (b)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

 

 

(f) New York net estate tax, as if a resident

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The undersigned states that the foregoing sets forth all of the assets constituting the decedent’s gross estate, and the answers to the foregoing questions are each and everyone true in every particular, and that this affidavit is made to induce the Commissioner of Taxation and Finance to determine domicile, to give a waiver notice and/or release of lien required by the Tax Law of the State of New York.

Fiduciary or applicant — sign here

Sworn before me this

 

day of

 

, 20

 

,

in the County of

 

 

 

 

 

 

 

 

,

in the State/Commonwealth/Province of

 

 

 

 

 

 

 

.

Qualified in the County of

 

 

. Commission expires on

, 20

 

.

 

 

 

 

 

 

 

 

 

 

 

 

(Notary Public, Commissioner of Deeds or Authorized New York State Department of Taxation and Finance employee)

• Attach authentication certificate if this affidavit is sworn to in a foreign country.

Note: Disclosure of social security number is required. Such numbers are used for tax administration purposes and as necessary pursuant to Education Law, sec. 663; Social Services Law, sec. 111b and 136a; and Executive Law, sec. 49; and Tax Law, sec 171b, and when the taxpayer gives written authorization to this department for another department, person, agency, or entity to have access, limited or otherwise, to information contained in his or her return.

Notice — Section 1811(b) of the Tax Law provides that any person who, with intent to evade taxation, files a false or fraudulent return, supplies false or fraudulent information, or withholds material information with intent to deceive, shall be guilty of a misdemeanor.

Table A – Tax table — If the amount with respect to which the tax is to be computed is:

Over

 

But not over

The tax is:

 

 

 

 

 

 

 

 

 

 

 

 

$

0

$

50,000

 

 

 

2% of such amount

 

 

50,000

 

150,000

$

1,000

+

3% of excess over $

50,000

 

150,000

 

300,000

 

4,000

+

4% of excess over

150,000

 

300,000

 

500,000

 

10,000

+

5% of excess over

300,000

 

500,000

 

700,000

 

20,000

+

6% of excess over

500,000

For amounts over $700,000 refer to instructions TT-86.5-I (3/90) page 10, Table A, or TT-102-I (1/94) page 4, Table A.

 

 

 

Table B – Unified credit — If the tentative tax is:

 

 

 

 

 

 

 

 

 

 

 

Over

 

But not over

 

 

The credit is:

 

 

 

 

 

 

 

 

 

 

$

0

$

2,750

 

 

the full amount of tax

 

 

2,750

 

5,000

 

 

the amount by which $5,500 exceeds the tax

 

5,000

 

 

 

 

$500