State of Connecticut
Department of Revenue Services
APPLICATION FOR CERTIFICATE
Inheritance/Estate Tax Section
RELEASING CONNECTICUT SUCCESSION
PO Box 2972
Hartford CT 06104-2972
AND ESTATE TAX LIENS
Complete a separate Form CT-4422 and Form CT-792 for each property location for which a release of lien is requested.
Decedent’s name (last, first, middle initial)
Date of death
Decedent’s residence at date of death (street address)
Connecticut file number, if known On the date of death, the decedent was a:
Resident of Connecticut
Social security number
Nonresident of Connecticut
PROPERTY DESCRIPTION AND ADDRESS: Enter the property being sold, transferred or mortgaged for which you are requesting a release of lien.
Description of the property (Attach Schedule A if necessary)
Was this property reported on the decedent’s Connecticut Form S-1 or
Is the estate required to file a federal Form 706, United States Estate
Form S-2, Succession Tax Return ?
(and Generation-Skipping Transfer Tax Return) ?
Not yet, but will be
ESTIMATED CONNECTICUT SUCCESSION AND ESTATE TAXES
1. Estimated gross estate
2. Estimated amount passing to each beneficiary class:
3. Estimated amount of Connecticut succession and estate taxes due
4. Prior payments made, if known
5. Estimated balance to be paid
6. Sales price or fair market value of property on date of death
7. Amount of mortgages held thereon at date of death
8. Payment with this application, if any
AFFIRMATION: I agree to hold sufficient proceeds to satisfy the Connecticut succession and estate taxes. I agree to make payment:
by the due date of such payment; or
at the time of closing, if after the due date. Late payments must include interest and penalty for the estate tax.
Name of attorney making this request for release
LEGAL RELATIONSHIP: Check the appropriate boxes below to
describe your status in this real estate transaction:
Signature of attorney
I am a Connecticut attorney representing the above-listed
Law firm name
I am a Connecticut attorney representing the seller in this real
I am a Connecticut attorney representing the buyer in this real
Other, please specify.