Form Au-101-B - Legacy, Succession And Estates Report Of Gifts, Transfers, Joint Tenancies And Trusts

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
LEGACY, SUCCESSION AND ESTATES
AU-101-B
REPORT OF GIFTS, TRANSFERS, JOINT TENANCIES AND TRUSTS
DECEDENT'S LAST NAME
FIRST NAME
MIDDLE INITIAL
DECEDENT'S SSN
DATE OF DEATH
STEP 1
Please
Print or
DOMICILE AT DATE OF DEATH
STREET
CITY/TOWN
STATE
ZIP CODE
APPLICABLE NH COUNTY
NH PROBATE NUMBER
Type
EXECUTOR, ADMINISTRATOR OR JOINT TENANT'S LAST NAME
FIRST NAME
MIDDLE INITIAL
EXECUTOR, ADMINISTRATOR OR JOINT TENANTS SSN OR FEIN
EXECUTOR, ADMINISTRATOR OR JOINT TENANT ADDRESS: STREET
CITY/TOWN
STATE
ZIP CODE
STEP 2
INITIAL
AMENDED
Type of
Filing
STEP 3
Gifts and Transfers of Real and Personal Property Valued Over $1000. If NONE, so state.
Property
Fair Market Value
Transferee
Of Property
Name and Address
Relationship To
Date of Transfer
Property Description
At Date of Death
of Transferee
Decedent
Mo
Day
Year
1
$
2
$
3
$
4
$
5
$
STEP 4
Real And Personal Property Held In Joint Tenancies With Decedent At Time Of Death. If NONE, so state.
Joint
Property
Fair Market Value
Transferee
Name and Address
Of Property
Relationship To
Date of Transfer
of Transferee
Property Description
At Date of Death
Decedent
Mo
Day Year
1
$
2
$
3
$
4
$
5
$
If real or personal property is held in trust, attach a completed copy of the trust and Form AU-101-C, Trust
STEP 5
Trust
Report to this document. File the copy of the Trust and Form AU-101-C only with the New Hampshire
Department of Revenue Administration.
STEP 6
Are you required to file a New Hampshire Legacy and Succussion Tax return (see instructions)?
YES
NO
NH Tax
Are you required to file a New Hampshire Estate Tax return (see instructions)?
YES
NO
Obligations
STEP 7
Under penalties of perjury, I declare that I have examined this form and to the best of my belief it is true, correct and complete. If prepared
Signatures
by a person other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.
SIGNATURE OF PAID PREPARER OTHER THAN EXECUTOR/ADMINISTRATOR
DATE
SIGNATURE
DATE
FOR DRA USE ONLY
Serving in the
PREPARER'S TAX IDENTIFICATION NUMBER
Capacity of:
Executor
Administrator
Joint Tenant
PREPARER'S ADDRESS
CITY /TOWN, STATE & ZIP CODE
Mail to: Applicable County Probate Office of
the decedents residence and the New
Hampshire
Department
of
Revenue
Administration. See instructions for address.
AU-101-B
Rev. 12/00

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