Form Ih-5 - Claim For Refund Of Inheritance And Estate Taxes
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1Prescribed by the Indiana Department of Revenue
Form IH-5
SF# 48834
(R2/04-07)
CLAIM FOR REFUND OF INHERITANCE AND ESTATE TAXES
Name of Decedent
Social Security Number
County of Residence
Address
Date of Death (if known)
Inheritance Tax File Number (if known)
Under Ind. Code § 6-4.1-10-1(a), the undersigned hereby makes claim for the refund of taxes paid in the aforemen-
tioned estate in the amount of ___________________________for the following reason:
I hereby certify that the tax was originally paid on the ______ day of __________________, 20_______, that the
______________________ County Treasurer issued receipt number _______________, and that no part of the same has
been refunded, except:
PLEASE ATTACH DOCUMENTARY EVIDENCE TO SUBSTANTIATE YOUR CLAIM.
Person Who Paid the Tax
Name of Person Making Claim
Relationship to Estate
Relationship to Estate
Address
Address
Note: Please mail completed form to: Indiana Department of Revenue, Inheritance Tax Division, 100 N. Senate
Ave., Room N248, Indianapolis, Indiana 46204-2253
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Parent category: Financial