INH
TENNESSEE DEPARTMENT OF REVENUE
300
STATE GIFT TAX RETURN
AMENDED RETURN
____ ____ ____ - ____ ____ - ____ ____ ____ ____
COUNTY
CALENDAR YEAR OF GIFT
DONOR'S SOCIAL SECURITY NUMBER
The Tennessee Gift Tax is due April 15 of
NAME OF DONOR _______________________________________________________
the year following the calendar year in
which gifts were made.
STREET ADDRESS ______________________________________________________
Make your check payable to the Tennes-
see Department of Revenue for the amount
CITY, STATE AND ZIP CODE ______________________________________________
shown on Line 8 and mail to:
If Donor is deceased, check here
and enter date of death ________________
Tennessee Department of Revenue
Andrew Jackson State Office Building
TERMINABLE INTEREST MARITAL DEDUCTION
500 Deaderick Street
1.Do you elect, under the rules of 2523(f) I.R.C., to claim a marital deduction for
Nashville, Tennessee 37242
gifts of qualified terminable interest property (QTIP)? YES
NO
2.Is the gift a disposition of qualified terminable interest property (QTIP) under T.C.A.
For assistance, you may call in-state toll
§67-8-101(e)?
YES
NO
free 1-800-342-1003 or (615) 253-0600.
CONSENT OF SPOUSE - GIFTS BY HUSBAND OR WIFE TO THIRD PARTIES
Do you consent to have the gifts by you and by your spouse to third parties during the calendar year considered as made one-half by
each of you?
YES
NO
If yes, consenting spouse must file return.
If the answer is "yes," complete Lines 1 through 3 and sign the consent line below:
1. Name of spouse __________________________________ Spouse's social security number ________________________
2. Were you married during the entire calendar year?
YES
NO
3. If the answer to 2 is "NO," check whether
married,
divorced, or
widowed, and give date
___________________
Consent of spouse - I consent to have the gifts made by me and my spouse to third parties during the calendar year considered
as made one-half by each of us. We are both aware of the joint and several liability for tax created by the execution of this consent.
Spouse's signature ___________________________________________________ Date ___________________________
Round to Nearest Whole Dollar
COMPUTATION OF TAX
Dollars
Cents
00
1. Total Class A Tax ...................................................................................................................
_________________________
00
2. Total Class B Tax ...................................................................................................................
_________________________
00
3. Total Tax (Add Lines 1 and 2) .................................................................................................
_________________________
00
4. Deduct: Extension payment ...................................................................................................
_________________________
00
5. Net Tax Due (Line 3 minus Line 4) .........................................................................................
_________________________
00
6. Penalty (5% for each 30-day period of delinquency not to exceed 25% of the tax due) ...........
_________________________
00
7. Interest (
% per annum on any taxes unpaid by the due date) ..................................
_________________________
00
8. Total Amount Due (Add Lines 5, 6, and 7) ..............................................................................
_________________________
00
9. Refund Due
_________________________
(Must complete and attach Report of Debts if claiming refund of $200 or more) ................
Under the penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is
true, correct and complete.
Donor's
FOR OFFICE USE ONLY
signature __________________________________________ Date ______________
Preparer's
Acct. # ____________________
signature __________________________________________ Date ______________
Date Rec'd ________________
Address __________________________________________ Phone _____________
Amt. Rec'd $ _______________
City/State _________________________________________ ZIP _______________
RV-R0001801
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