TENNESSEE DEPARTMENT OF REVENUE
Schedule D  INHERITANCE TAX RETURN SCHEDULE
INH         INSURANCE ON DECEDENT'S LIFE
301
ESTATE OF                                               DECEDENT'S SOCIAL SECURITY NUMBER

Was there any insurance on the decedent's life which is not included as a part of the gross estate?   Yes          No
If yes, full details must be submitted on this schedule.
Item                                                                                                                                             Value at
Number      Description                                                                                                                          Date of Death

1. Total ........................................................................................................................................

2. Total (From any attached sheets)............................................................................................

3. Total (Add Lines 1 & 2, enter here and also on Page 3, Line 4-D)..........................................

RV-F1400401                                                                                                                                      INTERNET (1-98)