Form 54-91 - Estate Tax Return - State Of North Dakota

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FORM 54-91
(Use for deaths occurring on or after 1-1-91)
Ì If Amended Return
Offi ce of
STATE OF NORTH DAKOTA
North Dakota
State Tax Commissioner
Date Received
ESTATE TAX RETURN
September 1, 2006
Decedent's Name
Date of Death
Age
Social Security Number:
Tax Dept. File Number
Tax Commissioner
Residence (domicile)
Number and Street
City or Township
County
State
Zip Code
at time of death
LEGAL CAPACITY OF APPLICANT
Did the decedent die testate? If Yes, attach copy of will.
Name and address of attorney
J Yes
J No
Name and address of personal representative
Name and location of court and type of proceeding
COMPUTATION OF TAX
1. Federal gross estate (from line 1, page 1, Federal Form 706) ................................................................. $ ___________________
2. Portion of federal gross estate having situs in North Dakota ................................................................. $ ___________________
3. Percentage of property in North Dakota - use 6-digit decimal only - (line 2 ÷ line 1) ........................... %___________________
4. Amount of credit for state taxes on Federal Return (from page 1, Federal Form 706) ........................... $ ____________________
5. North Dakota estate tax (line 4 multiplied by line 3) .............................................................................. $ ____________________
6. Interest due, if any, to date of payment (1% per month or any fraction thereof -
N.D.C.C. § 57-37.1-07) ........................................................................................................................... $ ____________________
7. Total estate tax plus applicable interest (line 5 plus line 6) ..................................................................... $ ____________________
8. Taxes previously paid .............................................................................................................................. $ ____________________
9. Additional tax plus applicable interest (line 7 minus line 8) ................................................................... $ ____________________
PLEASE ATTACH COMPLETE COPY OF FEDERAL FORM 706 AND,
IF APPROPRIATE, ATTACH NORTH DAKOTA FORMS 54.29 AND 131-3
MAIL TO: OFFICE OF STATE TAX COMMISSIONER, 600 E. BOULEVARD AVE. DEPT. 127, BISMARCK ND 58505-0599
Under criminal penalties, I declare that this return, including accompanying documents, has been examined by me, and is, to the best
of my knowledge and belief, true, correct, and complete.
____________________________________________________________________________
________________________________________________
(Signature of Applicant)
(Date)
Do Not Write
In This Space
_____________________________________________
______________
(Signature of Preparer)
(Date)
24137 (9-2006)

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