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NONPROBATE INVENTORY OF THE ESTATE

FOR DECEDENTS DYING ON OR AFTER JULY 13, 2001

ET 6.02

Rev. 03/02

TAX DEPARTMENT

PART 1: GENERAL INFORMATION QUESTIONNAIRE

USE ONLY

A. Decedent's Name

B. Social Security Number

C. Date of Death

D. Decedent's Residence at Death

E. State

F. County

G. Marital Status at Death: Married

Name of Surviving Spouse

Single, Widow(er) or Divorced

H. Fiduciary's Name and Mailing Address (include zip code)

I. Preparer's Name and Address

CPA

Attorney

Fiduciary's Phone Number

Preparer's Phone Number

PART 2: QUESTIONNAIRE OF NONPROBATE PERSONAL PROPERTY

Answer each of the following questions concerning the decedent's interest in NONPROBATE PERSONAL PROPERTY.

Nonprobate personal property means all property which does not pass by operation of the decedent's will or by the laws of intestate

descent and distribution or is otherwise not subject to administration in a decedent's estate.

Note: All real estate and probate property are to be reported on the Appraisement of the Estate (ET 6.01) filed with the County Commission.

If you answer "YES" to any question below, you must complete PART 3 of this form which shows:

the type of transfer(s) with reference to the question number below;

name(s) of the person(s) with an interest in the property as joint tenant or transferee;

relationship to the decedent of ALL above named persons;

market value at the date of death; and

description of the property.

MARKET VALUE

Did the decedent possess any powers of appointment? ................................................................ YES

Did the decedent make any gifts or transfers without adequate consideration within

three years prior to date of death?................................................................................................. YES

Did the decedent make any transfers in Trust which passed to others

upon his death? ............................................................................................................................. YES

Did the decedent own any stocks, bonds, bank accounts, certificates of

deposit or other personal property as a joint tenant with the right of survivorship? ........................ YES

Did the decedent own any life insurance policies to named beneficiaries?.................................... YES

Did the decedent own any annuities?............................................................................................ YES

Did the decedent own an interest in any personal property as a life tenant? ................................. YES

Did the decedent own any personal property which was payable on death to others? .................. YES

Did the decedent file any Federal Gift Tax Returns with the IRS or make any taxable

gifts under Federal Gift Tax law or regulations? ............................................................................ YES

10.

Did the decedent own any other nonprobate personal property includible in the

federal gross estate of a decedent? .............................................................................................. YES

TOTAL VALUE OF NONPROBATE PERSONAL PROPERTY (add lines 1 through 10 above)

11.

TAX DEPARTMENT USE ONLY (PA)

TAX DEPARTMENT USE ONLY (RE)

TAX DEPARTMENT USE ONLY (TOT)

Form Et 6.02 - Nonprobate Inventory Of The Estate For Decedents Dying On Or After July 13, 2001

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