Department of the Treasury–Internal Revenue Service 
                                                                                                               OMB Number 
   Form 4422              Application for Certificate Discharging Property                                        1545-0328
   (February 2018) 
                                            Subject to Estate Tax Lien
Name of decedent (last name, first name, middle initial)     Decedent's Social Security Number (SSN)     Date of death

Decedent's legal residence at time of death                                                              Estate's Employer 
                                                                                                         Identification Number (EIN)

As provided by Internal Revenue Code § 6325(c), I apply for a certificate discharging property subject to an estate tax lien. This 
property belongs to, or forms part of, the gross estate of the decedent named above.

If Form 706 has not been filed, provide estimate of  If Form 706 has been filed, provide date Amount of tax paid with filed or unfiled 
tax due                                                                                       return
$                                                                                             $
Give the gross estate values and deductions as reported on Form 706. If Form 706 has not been filed, show approximate amounts.

                    Gross Estate Values                                           Gross Estate Values (continued)

Real estate                       $                               All other property
                                                                  Gifts that will be reported or have 
Stocks and bonds                                                                                      $
                                                                  been reported on Form 709
Mortgages, notes, and cash                                                        Total Gross Estate  $

Insurance on decedent's life                                                                  Deductions

Jointly owned property                                            Funeral and administrative          $
                                                                  expenses
Transfers during decedent's life                                  Debts of decedent

Powers of appointment                                             Marital deduction

Annuities                                                         Other deductions

                                                                  Charitable gifts and bequests

                                                                                    Total Deductions  $

If property is to be sold, transferred, or mortgaged, complete the following and see additional instructions below.
a. Election made to value certain farm and  b. Request granted or will be      c. Payment deferred as provided by IRC § (“x” applicable 
   business real property as provided by       requested to defer payment         box)
   IRC § 2032A                                 of estate taxes
                                                                                    6161            6163          6166
   Yes                                                   Yes (Complete line c.)
   No                                                    No                       Amount paid with Form 4768 $
Name and address of the purchaser, transferee, or mortgagee                                  Relationship to applicant and decedent

                                                                                             Consideration paid or to be paid
                                                                                             $
   Under penalties of perjury, I declare that I have examined this application, including accompanying schedules, 
   exhibits, affidavits and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
                             Signature                                                                   Date signed
Applicant 
Sign here              ►

                             Signature                                                                   Date signed
Attorney for 
Applicant Sign here    ►

Catalog Number 41642G                                        www.irs.gov                                 Form 4422 (Rev. 2-2018) 

Name and address of applicant                              Name and address of attorney for applicant

Relationship of applicant to estate         Phone number of applicant          Phone number of attorney for applicant
(Executor, Administrator, or other title)
                                            (  )                               (       )
Physical address of the property being sold                                    Fax number of attorney for applicant
                                                                               (       )
Title or Escrow Company used for settlement   Contact name                     Phone number of contact

                                                                               (       )

                                         Instructions for Completing Form 4422,  
     Application for Certificate Discharging Property Subject to Estate Tax Lien 

1.  If property included in the gross estate is sold, the executor must request a discharge of the specified property 
from any applicable estate tax lien. 

     Submit your application at least 45 days before the transaction date the certificate of discharge is needed. 
Doing so will allow sufficient time for review, determination, notification and the furnishing of any applicable 
documents by the transaction date. If you have any questions, contact the Advisory Estate Tax Lien Group at 
(408) 283-2062, this is not a toll free number.

2.  Attach a statement giving your reasons for applying for this certificate.  

NOTE:  If we have issued any other discharges on this estate, please include the dates and the amounts.

3.  Attach a description of the property for which you want a certificate of discharge. Show the value of the property 
and the basis of the valuation. If the property consists of real estate, attach a separate legal description, the 
physical address of property being sold and a preliminary title report for each parcel.

4.  To facilitate timely processing of the application, attach any of the following documents that apply:

•  Short form of letters testamentary,

•  Copy of will,

•  Copy of sale contract and closing statement (or proposed closing statement),

•  Copy of the current title report and appraisal,

•  Copy of the Form 706
•  If return is not filed a draft of Form 706, and/or a copy of the inventory and appraisement reflecting all assets 
of the estate.
•  Form 4768, Application for Extension of Time to File a return and/or Pay U.S. Estate (and Generation-
Skipping Transfer) Taxes

5.  Submit a Form 8821, Tax Information Authorization. Completing this form gives the Internal Revenue Service the 
authority to contact individuals or companies, if necessary, when determining if the discharge is appropriate.

6.  Provide the name, address, telephone and fax number of the closing attorney or representative of the settlement 
company.

7.  The Internal Revenue Service may request that you furnish additional information and will have your application 
investigated to determine whether to issue the certificate. You will be informed of the outcome. 

Catalog Number 41642G                            www.irs.gov                            Form 4422 (Rev. 2-2018) 

8.  If Form 706 has not yet been filed or if the Internal Revenue Service has not completed our review of Form 706, 
  we will determine on a case by case basis the amount of funds, if any, the estate will be required to either pre-pay 
  from the sale proceeds or have held in escrow.
9.  Submit the completed Form 4422 and all supporting documents to: 
  
       Internal Revenue Service 
  Advisory Estate Tax Lien Group 
  55 South Market St. 
  Mail Stop 5350 
  San Jose, CA 95113-2324 
  Attn: Group Manager 
       E-fax number: 877-477-9243

10.  Requests for discharge of property described on lien Forms 668-H or 668-J will also be processed by the 
  Advisory Estate Tax Lien Group, requests may be sent to the above address.

                                 Paperwork Reduction Act
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB 
control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the 
administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. 
The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: Preparing and sending 
the form to the IRS should involve 30 minutes. The estimated burden for individual taxpayers filing this form is approved under OMB control number 
1545-0328 . If you have comments concerning the accuracy of the time estimate or suggestions for making this form simpler, we would be happy to hear 
from you. You can send your comments to Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, 
Washington, DC 20224. Do not send Form 4422 to this address.

Catalog Number 41642G                                       www.irs.gov     Form 4422 (Rev. 2-2018)