Form Et-115.1 - New York State Estate Tax Report Of Federal Audit Changes

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ET-115.1
New York State Department of Taxation and Finance
New York State Estate Tax Report of
(11/12)
Federal Audit Changes
For office use only
For an estate of an individual who died
on or after February 1, 2000
Decedent’s last name
First name
Middle initial
Social security number (SSN)
Address of decedent at time of death
Date of death
(number and street)
City
State
ZIP code
County of residence
If the decedent was a nonresident of New York State (NYS) on the date of death, mark an X in this box and attach a
completed Form ET-141, New York State Estate Tax Domicile Affidavit, if one was not submitted previously. .........................
Employer identification number (EIN) of the estate Name and EIN of any trusts created or funded by the will
Executor – If there has been a change of executor and you are submitting Letters Testamentary or Letters of
Administration with this form, indicate in this box the type of letters. Enter L if regular, LL if limited letters. If you are
not submitting letters with this form, enter N. ......................................................................................................................
Attorney’s or authorized representative’s last name
First name
MI
Executor’s last name
First name
MI
In care of
If POA is
If more than one executor, mark an X E-mail address of executor
(firm’s name)
attached,
in the box
(see Form ET-706-I)
mark an X
in the box
Address of attorney or authorized representative
Address of executor
City
State
ZIP code
City
State
ZIP code
SSN or PTIN of attorney or authorized rep.
Telephone number
Social security number of executor
Telephone number
(
)
(
)
If the decedent possessed a cause of action or was a plaintiff in any litigation at the time of death, mark an X in this
box and complete Schedule 3
.............................................................
(see Form ET-706-I, page 3, Litigation information)
Installment payments of tax for closely held business — Do you elect to pay the tax in installments as described
in Internal Revenue Code section 6166 (NYS Tax Law section 997)? If Yes, attach Form ET-415
...
Yes
No
(see Form ET-706-I)
a Taxable estate for New York State, as adjusted (
...........................
from Schedule A, line 26, or Schedule B, line 43)
b Gross federal estate tax for New York State
................................
(from Schedule A, line 31, or Schedule B, line 48)
1 New York State credit for state death taxes
..........................
1.
(from Schedule A, line 36, or Schedule B, line 51)
2 If there is property outside NYS that is included in the federal gross estate, see instructions on page 2;
otherwise enter 0 here and on lines 3, 5, 6, and 7, and enter the amount from line 1 on line 8 .................
2.
3 Residents enter amount from Schedule 1, line 14; nonresidents enter amount from Schedule 2, line 19 .........
3.
4 Total gross estate, less exclusion, for New York State (
.........
4.
from Schedule A, line 22, or Schedule B, line 39)
5 Divide line 3 by line 4
The result should not be greater than 1.0
5.
(round the result to the fourth decimal place).
6 Multiply line 1 by the decimal on line 5
.....................................................................
6.
(round to nearest cents)
7 Enter the amount from line 6, if any; otherwise enter 0 ...............................................................................
7.
8 New York State estate tax
.....................................................................................
8.
(subtract line 7 from line 1)
9 Prior tax payments to New York State, if any
...................................
9.
(attach a schedule of dates and amounts)
10 If line 9 is less than line 8, subtract line 9 from line 8. This is the amount you owe ................................... 10.
11 If line 9 is greater than line 8, subtract line 8 from line 9. This is the amount to be refunded to you ......... 11.
If an attorney or authorized representative is listed above, he or she must complete the following declaration.
I declare that I have agreed to represent the executor(s) for the above estate, that I am authorized to receive tax information regarding the
estate, and I am
an attorney
a certified public accountant
an enrolled agent
(mark an X in all that apply):
a public accountant enrolled with the New York State Education Department
Signature of attorney or authorized representative
Date
E-mail address of attorney
Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Furthermore, I/we, as executor(s) for this estate, authorize the person, if any, named as my/our representative on this
report to receive confidential tax information regarding this estate.
Signature of executor
Date
Signature of co-executor
Date
Firm’s name if preparer other than executor
Signature of preparer other than executor
Date
(or yours if self-employed)
Address of preparer
City
State
ZIP code
Firm’s employer identification number
E-mail address of preparer
Preparer’s PTIN or SSN
Preparer’s NYTPRIN

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