Form Inh 301 - Inheritance Tax Return

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INH
RV-R0001602
INTERNET (2-15)
TENNESSEE DEPARTMENT OF REVENUE
301
INHERITANCE TAX RETURN
AMENDED RETURN
____
____
____
-
____
____
-
____
____
____
____
COUNTY OF TN PROBATE
DATE OF DEATH
DECEDENT'S SOCIAL SECURITY NUMBER
This return should be used for estates of dece-
NAME OF DECEDENT Last:
First:
MI: ____
dents whose date of death is on or after Janu-
ary 1, 1990. This return is due nine (9) months
ADDRESS (AT TIME OF DEATH) ____________________________________________
after the date of the decedent's death, unless
an extension of time is granted by the Depart-
______________________________________________________________________
ment. Please print in blue or black ink.
CITY:
State:
ZIP CODE: __________
Make your check payable to the Tennessee
Department of Revenue for the amount shown
on Line 10 and mail to:
Yes
No
Tennessee Department of Revenue
Andrew Jackson State Office Building
Election of Alternate Valuation
_________
_________
500 Deaderick Street
Nashville, Tennessee 37242
Election of Special Use Valuation
_________
_________
Gross Estate contains T.C.A. §67-8-304 (10) (QTIP) property ________
_________
For assistance, you may call in-state toll free
1-800-342-1003 or (615) 253-0600.
Age of Decedent ________ Did decedent have a will?
Yes
No (If Yes, attach a copy to the return).
Personal Representative's Name (executor, etc.) Last Name:
First Name:
MI: ___
Address Street:
City:
State:
Zip Code: _________
Personal Representative's Name (executor, etc.) Last Name:
First Name:
MI: ___
Address Street:
City:
State:
Zip Code: _________
Return Preparer: Last Name/Firm:
First Name:
MI:
Phone ____________
Address Street:
City:
State:
Zip Code: _________
Attorney For the Estate Last Name/Firm:
First Name:
MI:
Phone:
Address Street:
City:
State:
Zip Code: _________
ROUND TO THE NEAREST DOLLAR
Dollars
Cents
COMPUTATION OF AMOUNT DUE
00
1. Inheritance Tax ......................................................................................................................
_________________________
00
2. Deduct: Applicable Credits .....................................................................................................
_________________________
00
3. Inheritance Tax Payable (Line 1 minus Line 2) .......................................................................
_________________________
00
4. Tennessee Estate Tax ...........................................................................................................
_________________________
00
5. Total Taxes Due (Add Lines 3 and 4) ......................................................................................
_________________________
00
6. Deduct: Extension Payments .................................................................................................
_________________________
00
7. Balance of Tax Due (Line 5 minus Line 6) ..............................................................................
_________________________
00
8. Penalty (5% for each 30-day period of delinquency not to exceed 25% of the tax due) ...........
_________________________
00
9. Interest (________% per annum on any taxes unpaid by the due date) ..................................
_________________________
00
10. Total Amount Due (Add Lines 7, 8, and 9)..........................................................................
FOR OFFICE USE ONLY
Under the penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and
belief, it is true, correct and complete.
Personal
Acct. # ____________________
Representative's
signature __________________________________________ Date ______________
Date Rec'd ________________
Preparer's
signature __________________________________________ Date ______________
Amt. Rec'd $ _______________
Page 1

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