Form 4422 - Application For Certificate Discharging Property Subject To Estate Tax Lien
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1
2Department of the Treasury–Internal Revenue Service
4422
OMB Number
Application for Certificate Discharging Property
Form
1545-0328
(March 2017)
Subject to Estate Tax Lien
Name of decedent
Year legal residence was established
Date of death
(Last name, First name, Middle initial)
Decedent's legal residence at time of death
Decedent's social
security number
(SSN)
To: Internal Revenue Service,
As provided by Internal Revenue Code section 6325(c), I apply for a certificate discharging property subject to an estate tax lien. This
property belongs to, or forms part of, the gross estate of the decedent named above.
Form 706 has been filed
If “Yes,” give date it was filed
Amount of tax paid
Yes
No
$
Give the gross estate values and deductions as reported on Form 706. If Form 706 has not been filed, show approximate amounts.
Gross Estate Values
Gross Estate Values
(continued)
Real estate
$
All other property
Stocks and bonds
Total Gross Estate
$
Mortgages, notes, and cash
Deductions
Funeral and administrative
Insurance on decedent's life
$
expenses
Jointly owned property
Debts of decedent
Transfers during decedent's life
Marital deduction
Powers of appointment
Other deductions
Annuities
Charitable gifts and bequests
Total Deductions
$
If property is to be sold, transferred, or mortgaged, please complete the following.
a. Election made to value certain farm and
b. Request granted to defer
c. Payment deferred as provided by
(“x” applicable box)
business real property as provided by IRC
payment of estate taxes
section 2032A
Yes
6161
6166
Other
(Complete line c.)
(specify)
Yes
No
No
Name and address of the purchaser, transferee, or mortgagee
Relationship to applicant and decedent
Consideration paid or to be paid
$
Under penalties of perjury, I declare that I have examined this application, including accompanying schedules
and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Date signed
Applicant
►
Sign here
Name and address of applicant
Name and address of attorney for applicant
Relationship of applicant to estate
Phone number of applicant
Phone number of attorney for applicant
(Executor, Administrator, or other title)
(
)
(
)
4422
Form
(Rev. 3-2017)
Catalog Number 41642G
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