92A204 (3-12)
REAL ESTATE VALUATION INFORMATION FORM
Commonwealth of Kentucky
(PLEASE COMPLETE A SEPARATE FORM
DEPARTMENT OF REVENUE
FOR EACH PIECE OF REAL ESTATE)
ESTATE OF
HR CODE NUMBER
DATE OF DEATH
Individually Owned Yes No
Jointly Owned Yes No
Decedent’s Interest (%)
Qualified Terminable Interest Property Yes No
Previously Taxed Property Yes No
Gift Yes No
Address of Real Estate_______________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
I. FAIR CASH VALUE
(Complete this section if agricultural or horticultural value not claimed)
1.
Fair Cash Value on date of death .................................................................................
$ _________________________
2. Property Valuation Administrator’s Assessed Value
(before homestead exemption) value as of date of death ........................................
$ _________________________
If fair cash value at date of death is different from the property valuation administrator’s date of death value,
please explain.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
3. Sale Price (if sold or purchased within five years) ....................................................
$ _________________________
If fair cash value at date of death is different from the sale price, please explain.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
II. AGRICULTURAL or HORTICULTURAL VALUE
(Complete this section if the election is made to report the agricultural value or horticultural value for “qualified
real estate. ” This is only advantageous if the property passes to son(s)-in-law or daughter(s)-in-law.)
A. Agricultural or horticultural assessment of the land by
local property valuation administrator on date of death ..........................................
$ _________________________
B. Fair cash value assessment of the residence located on the
land by the local property valuation administrator on date of death ......................
$ _________________________
C. Agricultural or horticultural value of the land only on date of death ......................
$ _________________________
D. Fair cash value of the residence located on the land on date of death ...................
$ _________________________
E. Total of lines C and D ..................................................................................................
$ _________________________
GENERAL INFORMATION
Crop/Tillable Land (Number Acres)
Pasture/Nontillable Land (Number Acres)
Woodland (Number Acres)
Wasteland (Number Acres)
Distance From Nearest Town
Total Acres
Please submit a legal description of the land for recording of the tax lien required by KRS 140.350 if agricultural or
horticultural value is claimed.
Please submit the names and addresses of all heirs who receive agricultural property if agricultural or horticultural
value is claimed.