Form 4421 - Declaration - Executor'S Commissions And Attorney'S Fees
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1
2Department of the Treasury
Internal Revenue Service
DECLARATION
Executor's Commissions and Attorney's Fees
Estate of:
Date of Death:
declare under
I (We)
to administer this
penalties of perjury that my (our) total commissions of $
have been agreed upon and have been or
estate and total attorney's fees of $
will be paid as follows:
Social Security
Total Amount
Date Paid
Name and Address
of Payee
Number of Payee
Paid or to be Paid
or to be Paid
has been or will be claimed as
Of the commissions or fees shown above, only $
an income tax deduction. If the amounts or dates are changed, or if an election is made to claim
commissions or fees deducted on the estate tax return as an income tax deduction, the Internal Revenue
Service will be notified, and any resulting estate tax will be paid. The recipients of these commissions and
fees will report them for income tax purposes for the year received.
of
(Signature
Executor or Administrator)
(Date)
of
(Signature
Executor or Administrator)
(Date)
of
(Signature
Attorney)
(Date)
of
(Signature
Attorney)
(Date)
For Privacy Act Notice, see back of form.
Cat. No. 41641V
4421
Form
(Rev. 4-1987)
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