Form Dp-145 - Summary Of Estate

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FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-145
SCHEDULE A - SUMMARY OF ESTATE
Schedule A
ESTATE OF: LAST NAME
FIRST NAME
MIDDLE INITIAL
DECEDENT'S SSN
PART I
SUMMARY OF SPECIFIC BEQUESTS
VALUE OF ITEMS TO:
RELATIONSHIP
NON-TAXABLE
TAXABLE
NAME OF LEGATEE
TO DECEDENT
ITEM
LEGATEES
LEGATEES
1
$
$
1
2
$
$
2
3
$
$
3
4
$
$
4
5
$
$
5
$
6
$
6 Total From Supplemental Schedule ....................................................................................................
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
7
7
Total Specific Bequests (Non-Taxable)..............................................................................................
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
$
8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
8
Total Specific Bequests (Taxable)......................................................................................................
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
PART II
SUMMARY OF GIFTS, TRANSFERS, JOINT TENANCIES AND TRUSTS
VALUE OF ITEMS TO:
NON-TAXABLE
TAXABLE
RELATIONSHIP
LEGATEES OR
LEGATEES OR
NAME OF LEGATEE
TO DECEDENT
ITEM
JOINT TENANT
JOINT TENANT
9
$
$
9
10
$
$
10
11
11
$
$
12
12
$
$
13
13
$
$
14
$
$
14 Total From Supplemental Schedule .....................................................................................................
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
15
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
15
Total Gifts, Transfers, Joint Tenancies and Trusts (Non-Taxable)......................................................
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
16
$
16
Total Gifts, Transfers, Joint Tenancies and Trusts (Taxable).............................................................
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
PART III SUMMARY OF REST AND RESIDUE
COMPLETE THIS PART AFTER YOU HAVE COMPLETED PAGE 2 LINES 1 - 24
% OF
AMOUNT TO:
RELATIONSHIP
REST AND
REST AND
NON-TAXABLE
TAXABLE
NAME OF LEGATEE
TO DECEDENT
RESIDUE
RESIDUE
LEGATEES
LEGATEES
17
17
$
$
18
18
$
$
19
19
$
$
20
20
$
$
21
21
$
$
22 Total From Supplemental Schedule ....................................................................................................
22
$
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
23
Total Amount of Rest & Residue (Non-Taxable).................................................................................
23
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
24
Total Amount of Rest & Residue (Taxable).........................................................................................
24
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
DP-145
Schedule A
3
Rev. 11/00

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