Form IH-9
Prescribed by the Indiana Department of Revenue
SF# 48854
Not for Public
Access*
(R3 / 3-16)
STATE OF INDIANA
)
) SS:
INDIANA DEPARTMENT OF REVENUE
)
CAUSE NO. ______________________________________
SOCIAL SECURITY NO. ____________________________
IN THE MATTER OF THE ESTATE OF
)
)
________________________________ , Deceased. )
Order Determining Inheritance Tax Due For Indiana Resident
This matter having come before the department on this day, and the department being duly advised in the premises, now finds that:
1.
The decedent died a resident of ____________________ county on the ______ day of _________________, 20 ______.
2.
The inheritance tax return was filed with the department.
3.
The fair market value on the decedent’s date of death of the property interest subject to the inheritance tax is as follows:
Total Gross Fair Market Value of Estate
$ __________________________
Total Value of Allowable Deductions
$ __________________________
Total Net Fair Market Value of Estate
$ __________________________
4.
The amount of inheritance tax due, determined as indicated, is:
Name
Relationship
Value of Interest
Exemption
Tax Rate
Amount Of Tax
Total Tax $
5.
The interest rate on any delinquent inheritance tax due is ten percent (10%) per annum from the date of death until paid pursuant
to Ind. Code § 6-4.1-9-1.
6.
The total penalty for late filing of the inheritance tax return is fifty cents ($.50) per day for each day the return is delinquent up to a
maximum of fifty dollars ($50.00) as mandated by Ind. Code §
6-4.1-4-1 and 6-4.1-4-6.
7.
The description of all Indiana real property owned by the decedent at the time of death is attached hereto as Exhibit A and made a
part hereof as if included herein.
THEREFORE, IT IS ORDERED that the above named beneficiaries of this estate and/or their legal representative pay the amounts as
set forth above, this _____ day of _____________ , 20 ____ .
__________________________________
Indiana Department of Revenue
* Once completed, this form is confidential pursuant to Ind. Code § 6-4.1-12-12. To comply with Administrative Rule 9 and 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.