Form Ih-Ta - Affidavit Of Transferee Of Trust Property That No Indiana Inheritance Or Estate Tax Is Due On The Transfer

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Form IH-TA
SF# 48832
(R2/04-07)
STATE OF INDIANA
)
)SS:
COUNTY OF _______________________ )
IN THE MATTER OF THE ESTATE OF
)
Social Security Number ______ - ___ - ______
)
_____________________________, DECEASED. )
AFFIDAVIT OF TRANSFEREE OF TRUST PROPERTY THAT NO
INDIANA INHERITANCE OR ESTATE TAX IS DUE ON THE TRANSFER
Comes now ___________________, being fi rst duly sworn upon his/her oath, says that:
1. Transferee, ___________________________________________________, is a trust benefi ciary, successor
trustee (strike inappropriate terms) of the _____________________________________ Trust, under agreement
dated and signed on the ____ day of _______________, 20______ and last amended on the ____ day of
(month)
(year)
______________, 20______.
(month)
(year)
2. That the original grantor_____________________, of the trust died on the ____ day of ______________,
(month)
20______, a resident of ___________________, County, Indiana.
(year)
3. Transferee (a) is domiciled in Indiana, or (b) is a representative of _________________________, a corporation
doing business in Indiana. (Strike either (a) or (b), whichever is not pertinent.)
4. That the following personal property sought to be transferred is held by the trust:
Holding Institution
Account Number
Description of Property
Date of Death Value
5. That the transfer of the trust personal property is not subject to Indiana inheritance or estate tax for the following reason:
6. Transferee, by making this affi davit, says that the above trust personal property will be transferred to him/
her and is not subject to Indiana inheritance or estate tax and further says, under the penalties for perjury, that
the statements herein are true and correct to the best of such person’s knowledge and belief.
Signature of transferee
Name (typed or printed)
Address

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