Form A-101 - Estate Tax Return
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4Estate Tax Return
A-101
Web
North Carolina Department of Revenue
10-11
(For deaths occurring on or after January 1, 2011)
Decedent’s First Name
M.I.
Last Name
(USE CAPITAL LETTERS FOR NAME AND ADDRESS)
Amended
Return
Decedent’s SSN
Date of Death (MM-DD-YY)
If yes, enter county of residence
Was the decedent a resident
of North Carolina?
(Enter first
five letters)
Yes
No
Court Appointed:
Personal Representative’s Federal
Yes
Personal Representative’s Legal Name (If applicable)
Employer ID Number (If applicable)
No
Personal Representative’s First Name
M.I.
Last Name
Personal Representative’s SSN
Address
Apartment Number
City
State
Zip Code
Telephone
Fill in circle and complete information below if the closing certificate should be mailed to a
Attorney
or
Accountant
person other than the personal representative.
First Name
M.I.
Last Name
Address
Apartment Number
City
Zip Code
Telephone
State
Fill in applicable circles:
A federal extension of 6 months was requested for filing the federal estate return
A federal extension exceeding 6 months was requested for filing the federal estate return due to the personal representative being out of the country
A federal extension was requested for paying the estate tax due under IRC Section 6161
You elect installment payments in the same manner as elected for federal estate tax payments under IRC section 6166
Estate Tax Computation (Complete Lines 1 through 21)
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1. Total gross estate
1.
(From Federal Form 706, Page 1, Line 1)
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2.
2.
Allowable deductions
(From Federal Form 706, Page 1, Line 2)
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3.
Taxable estate
3.
(before state death tax deduction) (Line 1 minus Line 2)
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4. Adjusted taxable gifts
4.
(From Federal Form 706, Page 1, Line 4)
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5. Add Lines 3 and 4
5.
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6. Compute tax on amount on Line 5 using Table A-Unified Rate Schedule in Federal
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6.
Form 706 Instructions
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7. Total federal gift tax payable
7.
(From Federal Form 706, Page 1, Line 7)
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8. Line 6 minus Line 7
8.
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9. Allowable unified credit
9.
(From Federal Form 706, Page 1, Line 11)
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10. Line 8 minus Line 9
10.
(Do not enter less than zero)
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00
11. Enter the amount from Line 3
11.
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6 0 0 0 0
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12. Less adjustment to taxable estate
12.
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