Not for Public
Access*
IH-Exem
State Form 48831
(R4 / 5-14)
AFFIDAVIT OF NO INHERITANCE TAX DUE
STATE OF INDIANA
)
IN THE ______________________COUNTY _____________ COURT
) SS:
COUNTY OF _________________ )
CAUSE NO. _______________________________________
In the Matter of the Estate of: ______________________________________________ , deceased.
Address of Decedent: ____________________________________________________
____________________________________________________
County of Decedent’s Residence: ___________________________________________
Social Security Number of Decedent: ________________________________________
Date of Decedent’s Death: ________________________________________________
I, ____________________________________ (name of affiant), being duly sworn upon my oath, state
that: I am familiar with the facts set out in this affidavit as the ______________________ (state relationship of
affiant to Decedent or Decedent’s estate) of Decedent or Decedent’s estate. No inheritance tax is due by reason
of Decedent’s death because no transferee receives taxable transfers in excess of such transferee’s exemption
from inheritance tax as listed herein.
Following is a complete listing of all transfers subject to inheritance tax by reason of Decedent’s death
(enclose additional pages as necessary):
Description of Property
Manner of Transfer
Date of Death Value
_____________________________
________________________
_________________________
_____________________________
________________________
_________________________
_____________________________
________________________
_________________________
_____________________________
________________________
_________________________
_____________________________
________________________
_________________________
_____________________________
________________________
_________________________
Total Value of All Taxable Transfers by Decedent (Gross Estate)
_________________________
(-) Less total expenses of decedent/estate**
_________________________
(=) Taxable estate
_________________________
* Once completed, this form is confidential pursuant to Ind. Code § 6-4.1-12-12. To comply with Trial Rule 5(G), this form is marked
“Not for Public Access” and is required to be filed on light green paper if it is filed for an otherwise public estate.
** Enclose an itemized list of deductions. See, Ind. Code § 6-4.1-3-13.