R-3313 (7/99)
State of Louisiana
Department of Revenue
P.O. Box 201
Baton Rouge, LA 70821-0201
Inheritance Tax Waiver and Consent to Release
I,
, Secretary of Revenue for the State of Louisiana,
DO HEREBY CERTIFY that an heir, executor, administrator, attorney, or other legal representative of the succession (or
estate) of _______________________________________________________________ has duly notified me of the
anticipated release, transfer, or payment to one or more legal heirs, legatees, or life insurance beneficiaries of the following
described property and/or funds, to wit:
Item (If more than four items, attach a separate schedule.)
Estimated Value
_________________________________________________________________
_________________________________________________________________
$ ___________________
_________________________________________________________________
_________________________________________________________________
$ ___________________
_________________________________________________________________
_________________________________________________________________
$ ___________________
_________________________________________________________________
_________________________________________________________________
$ ___________________
Holder's name and address
______________________________________________________________
______________________________________________________________
______________________________________________________________
BY VIRTUE OF THE AUTHORITY VESTED IN ME, CONSENT IS HEREBY GRANTED to any holder of said property
and/or funds to effect release, transfer, or payment thereof to such legal heirs, legatees, or life insurance beneficiaries,
in accordance with law. The said holders, transferors, or payers of said property and/or funds, as well as their agents and
employees, are hereby held free and harmless from any and all Louisiana inheritance tax liability that may be due or later
become due with respect to property and/or funds covered by this consent. All rights of the Department of Revenue to
collect said inheritance tax are expressly reserved against said succession or estate, its heirs and legatees.
THUS DONE AND SIGNED at
, Louisiana, this _____ day of
, _______ .
year
State of Louisiana
Secretary of Revenue
______________________________________________
By:
A copy of the signed court order or judgement of possession must be attached.