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Department of Revenue Services

Form CT-4422 UGE

Estate Tax Section

PO Box 2972

Application for Certiﬁ cate Releasing Connecticut Estate Tax Lien

Hartford CT 06104-2972

For estates of decedents dying on or after January 1, 2005

(Rev. 05/17)

Complete this form in blue or black ink only.

Complete a seperate Form CT-4422 UGE for each property location for which a release of lien is

requested.

Decedent’s name (last, ﬁ

rst,

middle initial)

Date of death

Connecticut Probate Court

__ __

__ __ __ __

PD -

m m

d d

y y y y

Decedent’s residence at date of death (street address)

Social Security Number (SSN)

•

__ __ __

•

__ __

•

__ __ __ __

•

City, town, or post ofﬁ ce

State

ZIP code

Federal Employer ID Number (FEIN)

(If applicable)

Mailing address (ﬁ rm name and name of attorney)

Number and street

PO Box

City, town, or post ofﬁ ce

State

ZIP code

Property address for which release is being requested

(attach legal description, if

necessary):



the

date of death, decedent was:

Connecticut resident



Nonresident - Attach Form C-3, State of Connecticut Domicile Declaration, and death certiﬁ cate.

Was this property reported on the decedent’s

Is the estate required to ﬁ le a federal Form 706,

If Form CT-706/709 EXT, Application for Estate

Connecticut Form CT-706/709, Connecticut

United States Estate (and Generation-Skipping

and Gift Tax Return Filing Extension and for

Estate and Gift Tax Return?

Transfer)

Tax Return?

Estate Tax Payment Extension, was ﬁ led, enter

the extended due date:







Yes

N o

Not yet, but will be

Yes

N o

__ __

__ __ __ __

m m

d d

y y y y

Date of Closing:

__ __

__ __ __ __

Section 1 - Estimated Connecticut Estate Taxes

m m

d d

y y y y

1. Sales price or fair market value of property on date of death

2. Estimated Connecticut taxable estate

3. Estimated amount of Connecticut estate and gift taxes due: See Tax Table for Form CT-706/709.

4. Prior payments made

5. Estimated balance to be paid: Subtract Line 4 from Line 3.

6. Payment made with this application

Section 2

Afﬁ rmation: To the best of my knowledge and belief, the property for which the release of lien is being requested is or was in an estate

for which the amount of the Connecticut taxable estate exceeds the exemption amount for the year of death; and

I agree to hold sufﬁ cient proceeds in a Connecticut escrow account to satisfy the total amount of Connecticut estate and gift taxes, interest,

and penalty, if applicable, which may be due. I agree to make payment:





By the payment due date; or





At the time of

closing,

if after the due date. Late payments must include interest and penalty, if applicable.

Section 3

Legal Relationship: Check the appropriate boxes to describe your status in this real estate transaction.

A. Connecticut attorney representing:



Decedent’s estate listed above

Seller in this real estate closing

Buyer in this real estate closing

B. Corporate ﬁ duciary of:



Decedent’s estate listed above 

Seller in this real estate closing

Buyer in this real estate closing

Name of applicant

Telephone number

Fax number

(

)

(

)

Address of applicant

City, town, or post ofﬁ ce

State

ZIP code

Signature of attorney or corporate ﬁ duciary

Date

P:\Special\AFP\PROD\FORMS\17\CT\CT-4422 UGE\CT-4422 UGE 20170530.indd

20170530 9:06 AM

Form Ct-4422 Uge Draft - Application For Certifi Cate Releasing Connecticut Estate Tax Lien

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