Form 92a201 - Kentucky Inheritance Tax Return - Kentucky Department Of Revenue

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92A201 (3-12)
Kentucky Inheritance
FOR DEPARTMENT USE ONLY
Commonwealth of Kentucky
Tax Return
DEPARTMENT OF REVENUE
4 6
__ __ __ __ __ __ / __ __ / __ __ / __ __ __ __
NO TAX DUE
Account Number
Tax
Mo
Year
This return may be used if: (1) there is no Kentucky inheritance tax due, (2) the date of death is on or after January 1, 2005, and
(3) the entire estate passes to beneficiaries listed in the following groups either by contract (survivorship, payable on death, trust,
etc.), the decedent’s will, or the intestate laws of this state:
(1)
Surviving spouse, parent
(2)
Child (adult or infant)
child by blood, stepchild, child adopted during infancy,
or a child adopted during adulthood who was reared by decedent during infancy
(3)
Grandchild
issue of child by blood, stepchild, child adopted during infancy,
or of a child adopted during adulthood who was reared by decedent during infancy
(4)
Brother, sister (whole or half)
➤ Refer to KRS 140.080 for (1) through (4) above
(5)
Exempt organizations—Refer to KRS 140.060
Exempt organizations include educational, religious or other institutions, societies, or associations, whose sole purpose
is to carry on charitable, educational, or religious work. Also, cities, towns or public institutions in this state qualify as
exempt organizations provided that any transfer to such an organization is for public purposes.
Decedent’s Name Last
First
Middle Initial
Date of Death
Social Security Number
Occupation
(If decedent was retired
HR Code Number (if known)
Age at Death
Cause of Death
at death, state occupation 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?
No
Yes If Yes, attach a copy of the will.
Filing status of Federal Estate and Gift Tax Return for this estate (check one):
Not Required
Required (enclose copy)
Schedules for listing property (real and personal) and beneficiaries are on the reverse side of this form. Listing of
property is optional. Listing of beneficiaries and their relationship is required.
Total Value of Property from Reverse Side .........................................(optional) ➤ $
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
E-mail Address
(
)
Signature of Preparer
Date
Telephone Number
E-mail Address
Mail to: Kentucky Department of Revenue, Frankfort, Kentucky 40620

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