Schedule Cc - Request For A Closing Certificate For Fiduciaries - 2012

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Request for a Closing Certificate
SCHEDULE
CC
for Fiduciaries
2012
Use
Wisconsin Department of Revenue
u
u
BLACK INK
ESTATES ONLY – Legal last name
Legal first name
Decedent’s social security number
M.I.
TRUSTS ONLY – Legal name
Estate’s/ Trust’s federal EIN
Individual or firm to whom the closing certificate should be mailed
Attention or c/o
County of jurisdiction
Probate case number
Address
City
State
Date of decedent’s death
Zip code
(MM DD YYYY)
Information Required When Requesting a Closing Certificate for Estates
PART I
Complete lines 1 through 11 and sign on page 2.
1. Does the decedent have a will?
Yes
No
(If Yes, enclose a copy)
2. Type of probate
Formal
Informal
Other
3. If the decedent did not file tax returns for the 4 years prior to death, enter the year and the decedent’s approximate income:
20
$
,
20
$
,
20
$
,
20
$
.
4. Was the decedent contacted by the IRS and/or Wis. Dept. of Revenue in the last 3 years?
Yes
No
If Yes, explain:
5. Is the gross income of the estate
less than $600? ..................................................
Yes
No
6. Will a final Form 2 be filed at a later date? .........
Yes
No
7. Is a certificate required by the court? .................
Yes
No
See instructions.
8. Was the decedent a resident of Wisconsin
at the time of death? ..........................................
Yes
No
9. Did the decedent own an interest in any
partnership, S corporation, LLC, or LLP? ...........
Yes
No
10. Enter the totals of each of the assets listed below.
Probate Assets (Enclose a copy of the inventory)
NO COMMAS; NO CENTS
a. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a
.00
b. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b
.00
c. Mortgages, Notes, and Cash . . . . . . . . . . . . . . . . . . . . . . . . . . 10c
.00
.00
d. Land Contracts and Installment Sales . . . . . . . . . . . . . . . . . . . 10d
NOTE
W h e r e a n y l i n e
.00
e. Insurance Payable to Estate . . . . . . . . . . . . . . . . . . . . . . . . . . 10e
from 10a through
10L is left blank,
.00
f. Annuities and Employee Death Benefits Payable to Estate . . . 10f
it will be deemed
g. Other Miscellaneous Property . . . . . . . . . . . . . . . . . . . . . . . . . 10g
.00
that NONE is the
D E C L A R AT I O N
Nonprobate Assets
for that line by the
h. Jointly Owned Survivorship – Decedent’s
person(s) signing
Share of Jointly Owned Property . . . . . . . . . . . . . . . . . . . . . . . 10h
Schedule CC.
.00
i. Decedent’s Share of Survivorship Marital Property . . . . . . . . . 10i
.00
j. Insurance Payable to Named Beneficiaries . . . . . . . . . . . . . . . 10j
.00
k. Transfers During Decedent’s Life
.00
. . . . . . . . . . . . . . . 10k
(gifts, etc.)
L. Other Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10L
.00
m. Wisconsin GROSS Estate (add lines 10a through 10L) . . . . . . . . . . . . . . . . . . . . . . . 10m
.00
11. Fiduciary fees paid or payable to the personal representative or trustee . . . . . . . . . . . . . . 11
.00
I-030i (R. 9-12)

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