Form 4422 - Application For Certificate Discharging Property Subject To Estate Tax Lien
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1
2Year legal residence
Department of the Treasury – Internal Revenue Service
4422
was established
Application for Certificate Discharging
Form
Property Subject to Estate Tax Lien
(Rev. April 2010)
Name of decedent
Date of death
(Last name, First name, Middle initial)
Decedent's social security
Decedent's legal residence at time of death
number
(SSN)
To: Area Director, Internal Revenue Service,
As provided by Internal Revenue Code section 6325(c), I apply for a certificate discharging property subject to an estate tax lien. This
property belongs to, or forms a part of, the gross estate of the decedent named above.
Form 706 has been filed
If “Yes,” give date it was filed
Amount of tax paid
Yes
No
$
Give the gross estate values and deductions as reported on Form 706. If Form 706 has not been filed, show approximate amounts.
Gross Estate Values
Gross Estate Values
(continued)
Real estate
All other property
$
Total Gross Estate
Stocks and bonds
$
Mortgages, notes, and cash
Deductions
Funeral and administrative
Insurance on decedent's life
$
expenses
Jointly owned property
Debts of decedent
Transfers during decedent's life
Marital deduction
Powers of appointment
Other deductions
Annuities
Charitable gifts and bequests
Total Deductions
$
If property is to be sold, transferred, or mortgaged, please complete the following.
a. Election made to value certain farm and
b. Request granted to defer
c. Payment deferred as provided by
(“x” applicable box)
business real property as
payment of estate taxes
provided by IRC section 2032A
Yes
6161
6166
Other
(Complete Item c.)
(specify)
Yes
No
No
Relationship to applicant and decedent
Name and address of the purchaser, transferee, or mortgagee
Consideration paid or to be paid
$
Under penalties of perjury, I declare that I have examined this application, including accompanying schedules
and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Date signed
Applicant
Sign here
Name and address of applicant
Name and address of attorney for applicant
Relationship of applicant to estate
Phone number of applicant
Phone number of attorney for applicant
(Executor, Administrator, or other title)
(
)
(
)
4422
Catalog No. 41642G
Form
(Rev. 4-2010)
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