Form 92a200 - Kentucky Inheritance Tax Return
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17FOR DEPARTMENT USE ONLY
92A200 (3-12)
KENTUCKY
INHERITANCE TAX RETURN
Commonwealth of Kentucky
4 6
__ __ __ __ __ __ / __ __ / __ __ / __ __ __ __
DEPARTMENT OF REVENUE
Account Number
Tax
Mo
Year
Requirements for use of this return—This return is to be filed when
Return Status (check one):
(1) the date of death is on or after January 1, 2005, (2) any assets of
Original Return
the estate pass to taxable beneficiaries or taxable organizations, (see
Amended Return—Refund
page 4 of general information) and (3) Forms 92A201 and 92A205 do
Amended Return—Tax Due
not apply.
Decedent’s Name Last
First
Middle Initial
Occupation (If decedent was
Age at Death
Date of Death
retired at death, state occu-
pation prior to retirement.)
Social Security Number
Cause of Death
HR Code Number
Residence (Domicile) at Time of Death
Number and Street
City
State
ZIP Code
County
Name and Address of Executor/Administrator/Beneficiary
Name and Address of Preparer
Exec
Atty
Admr
CPA
________
________
Did the decedent have a will?
No
Yes If Yes, attach a copy of the will.
Filing status of Federal Estate and Gift Tax Return for this estate (check one):
Not Required
Required (a copy must be attached)
Gross Estate
1. Individually owned assets ..................................................................... $
2. Jointly owned assets ............................................................................. $
3. Qualified terminable interest property
and/or powers of appointment ............................................................. $
4. Previously taxed property ..................................................................... $
5. Gifts and transfers ................................................................................. $
Total Gross Estate ............................................................................................ $
Deductions
6. Funeral expenses ................................................................................... $
7. Administration expenses ...................................................................... $
8. Debts of decedent .................................................................................. $
9. Federal estate tax—
paid or
estimated ................................... $
Total Deductions ............................................................................................... $
Net Estate (Total Gross Estate less Total Deductions) ................................... $
Total Tax Due from Tax Computation Form 92A200 ....................................... $
Interest and Penalty
10. Interest for late payment (see general information) .................................................................... $
11. Late filing penalty (see general information) ............................................................................... $
12. Late payment penalty (see general information) ......................................................................... $
13. Total Due (tax plus interest and penalties, if applicable) ............................................................ $
14. Total previously paid ...................................................................................................................... $
15. Balance due/Refund ....................................................................................................................... $
Attach check payable to “Kentucky State Treasurer” to this return and mail to Kentucky Department of Revenue, Frankfort, KY 40620
✍
Under criminal penalties, I declare that this return, including accompanying documents, has been examined by me, and is, to the best
of my knowledge and belief, true, correct and complete.
(
)
Signature of Executor/Administrator/Beneficiary
Date
Telephone Number
E-mail Address
(
)
Signature of Preparer
Date
Telephone Number
E-mail Address
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