F
ET 6.01
ApprAisement of the estAte
orm
for DeceDents Dying on or After July 13, 2001
Rev. 06/14
pArt 1: generAl informAtion QuestionnAire
A. Decedent’s Name
B. Social Security Number
C. Date of Death
D. Decedent’s Residence at Death
E. State
F. County
Marital Status at Death
Name of Surviving Spouse
H. West Virginia Counties Where Decedent Held Real Estate.
G.
Married
Single, Widow(er) or Divorced
I. Will this estate be required to file a Federal Estate Tax Return form 706 (see instructions on page 2)?
YES
NO
J. Will this estate be required to file the nonprobate inventory form et 6.02 (see instructions on page 3)?
YES
NO
K. Did the Decedent leave a Will?
YES
NO
L. Fiduciary’s Name and Mailing Address (include zip code)
M. Preparer’s Name and Address
CPA
Attorney
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Fiduciary’s Phone Number:
Preparer’s Phone Number:
pArt 2: QuestionnAire of nonprobAte reAl estAte
Answer each of the following questions concerning the decedent’s interest in NONPROBATE REAL ESTATE.
if you answer “yes” to any question below, you must complete the attached inventory of nonprobate real estate provided
with this form which shows:
a.
the type of transfer(s) with reference to the question number below;
b.
name(s) of the person(s) with an interest in the real estate as joint tenant or transferee;
c.
relationship to the decedent of ALL above named persons;
d.
market value at the date of death; and
e.
description of the real estate including assessed value.
mArket VAlue
1
1. Did the decedent own an interest in any real estate as joint tenant with right of survivorship?................................... YES
NO
2. Did the decedent transfer an interest in any real estate without adequate consideration within three years prior to
2
date of death?..............................................................................................................................................................YES
NO
3. Did the decedent own an interest in any real estate in an inter vivos trust (living trust) arrangement or in which the
3
decedent retained the right of use and enjoyment?.....................................................................................................YES
NO
4. Did the decedent own an interest in any real estate in which the decedent retained a power of appointment,
4
whether special or general?......................................................................................................................................... YES
NO
5
5. Did the decedent own an interest in any real estate as a life estate including a dower interest?................................ YES
NO
6
6. Did the decedent own an interest in any real estate transferable by a transfer on death deed?................................. YES
NO
7
7. ToTal value of nonprobaTe real esTaTe (add lines 1 through 6 above)...........................................................................................
pArt 3: summAry of probAte Assets
Complete PART 4 first. Enter the total from each schedule of PART 4 on the appropriate line below.
mArket VAlue
1
1. Schedule A: Real estate or any interest therein...................................................................................................................................................
2
2. Schedule B: Tangible personal property of every kind.........................................................................................................................................
3
3. Schedule C: Government bonds and securities of every kind.............................................................................................................................
4
4. Schedule D: Shares of corporate stock of every kind..........................................................................................................................................
5
5. Schedule E: Money, certificates of deposit, notes, accounts, etc. ......................................................................................................................
6
6. Schedule F: All other assets not hereinbefore mentioned.....................................................................................................................................
7
7. ToTal value of probaTe asseTs (add lines 1 through 6 above)..............................................................................................................
Form ET 6.01
West Virginia State Tax Department
Page 1