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Kentucky Inheritance

92A205 (3-12)

FOR DEPARTMENT USE ONLY

Commonwealth of Kentucky

Tax Return

DEPARTMENT OF REVENUE

4 6

__ __ __ __ __ __ / __ __ / __ __ / __ __ __ __

Account Number

Tax

Year

(Short Form)

This form is designed for small, uncomplicated estates. Requirements for use

of this return—This return may be used when (1) a federal estate tax return is

not required to be filed, (2) the assets of the estate consist of 10 items or less,

Return Status (check one):

(3) no gifts or transfers were made within three years of death without full

 Original Return

consideration, (4) no real or personal property was transferred with a retained

 Amended Return—Refund

life interest, (5) the decedent did not possess any power to appoint any real or

 Amended Return—Tax Due

personal property or have the use of any qualified terminable interest property,

and (6) the decedent had not received any real or personal property from another

decedent within five years and paid inheritance tax on the property.

Decedent’s Name Last

First

Middle Initial

Date of Death

Occupation (If decedent was

Social Security Number

Age at

Cause of Death

HR Code Number (if known)

retired at death, state occu-

Death

pation prior to retirement.)

Residence (Domicile) at Time of Death

Number and Street

City

State

ZIP Code

County

Name and Address of Executor/Administrator/Beneficiary

Name and Address of Preparer



Exec

Atty



Admr

CPA



_______

Did the decedent have a will?



Yes If Yes, attach a copy of the will.

Net Estate (from page 2) ......................................................................................................................

Inheritance tax due from Section III on reverse side .........................................................................

Discount of 5% from tax if paid within 9 months from death ...........................................................

–

Total Tax Due ........................................................................................................................................

Interest and Penalty

Interest for late payment (see general information) ............................................................................... $

Late filing penalty (see general information) ........................................................................................... $

Late payment penalty (see general information) .................................................................................... $

Total due (tax plus interest and penalties, if applicable) ......................................................................... $

Total previously paid .................................................................................................................................. $

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.

(

)



Signature of Executor/Administrator/Beneficiary

Date

Telephone Number