Form 92a202 - Estate Tax Return - 2011
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192A202 (4-11)
Kentucky Estate Tax Return
FOR DEPARTMENT USE ONLY
Commonwealth of Kentucky
KRS 140.130
DEPARTMENT OF REVENUE
4 6
__ __ __ __ __ __ / __ __ / __ __ __ __
Account Number
Tax
Year
Requirements for use of this return—This return is to be filed when: (1) the date of death is on or after July 1,1998, and (2) the
entire estate passes to exempt beneficiaries under KRS 140.080 or to exempt organizations under KRS 140.060, and (3) Kentucky
estate tax is due per KRS 140.130.
Date of Death
Decedent’s Name Last
First
Middle Initial
Return Status (check one):
Original Return
Amended Return—Refund
Social Security Number
HR Code No.
Amended Return—Tax Due
Residence (Domicile) at Time of Death
Number and Street
City or Town
State
ZIP Code
County
Name and Address of Executor/Administrator/Beneficiary
Name and Address of Preparer
Exec
Atty
Admr
CPA
________
________
Did the decedent die testate? No
Yes If Yes, attach copy of will.
Required attachments to this return: (1) A copy of the Federal Estate and Gift Tax Return.
(2) A listing of all beneficiaries and their relationship to decedent.
COMPUTATION OF TAX
1.
Total state death tax credit for federal estate tax purposes ............................................
$
2.
Federal taxable estate (page 1, line 3, Form 706, Federal Estate and Gift Tax Return) ...
$
3.
Kentucky’s portion of line 2 (Kentucky assets for federal estate tax purposes
less applicable deductions) ................................................................................................
$
4.
Non-Kentucky portion of line 2 (non-Kentucky assets for federal estate tax purposes
less applicable deductions) ................................................................................................
$
5.
Percent that line 3 bears to line 2 ......................................................................................
%
6.
Kentucky’s portion of the federal state death tax credit (line 1 multiplied by line 5) ....
$
Kentucky Estate Tax Due ...................................................................................................
$
Interest and Penalty
7.
Interest for late payment (see instructions on reverse side) ...........................................
$
8.
Late filing penalty (see instructions on reverse side) ......................................................
$
9.
Late payment penalty (see instructions on reverse side) ................................................
$
10.
Total Due (line 6 plus lines 7, 8 and 9 (if applicable)) .......................................................
$
11.
Total previously paid ..........................................................................................................
$
12. Balance due/Refund ............................................................................................................
$
Attach check payable to “Kentucky State Treasurer” to this return and mail to
Kentucky Department of Revenue, Frankfort, KY 40620
✍
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.
(
)
_____________________________________________________
______________________
_____________________________
Telephone Number
Signature of Executor/Administrator/Beneficiary
Date
(
)
_____________________________________________________
______________________
_____________________________
Signature of Preparer
Date
Telephone Number
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