State of Rhode Island Division of Taxation 
  Form ESTATE-V 
  Estate Tax Fee Payment Voucher Form                                                                  16160399990101

                                                    ESTATE TAX FEE FORM 
Decedent's first name                                     MI     Last name                             Suffix Decedent's social security number

Decedent's address - Legal residence (domicile) at time of death             City, town or post office                         State          ZIP code

Foreign country, if applicable                           Year domicile established Date of birth                               Date of death

Executor/personal rep/admin's first name               MI     Last name                                Suffix Executor's social security number

Executor's address                                                           City, town or post office                         State          ZIP code

Preparer's first name                                       MI     Last name                           Suffix Preparer telephone number

Preparer's firm name, if applicable

Preparer's address                                                           City, town or post office                         State          ZIP code

Name and location of court where will was probated or estate administered                                     Case number

Part 1:  Reason for paying $50 fee  NOTE: This form is to be used only to pay the $50 fee, not the estate tax. 
Check the box next to the reason for which you are making a payment.  Check only one box. 

  Form 706 return filing

  Form 706 - Pro Forma return filing

  Form 706 - Amended return filing

  Change or correction to information on Form T-77, Discharge of Estate Tax Lien (Taxable Estates only)

  Change or correction to information on Form T-79, Application for Estate Tax Waiver (Taxable Estates only)

  Other:_______________________________________________________________________________

Part 2:  Amount due
1 Amount enclosed............................................................................................................ 1
                                                                                                                                              50  00
Executor/personal representative/administrator signature                                        Date                           Telephone number

Preparer signature                                                                              Date                                      PTIN

I declare that I am the Attorney   Certified public              Enrolled    for the executor and prepared this return for the executor.  I am not under suspension or 
(Please check one)                 accountant                    agent       disbarment from practice before the IRS and am qualified in the state shown above.

                                   May the Division of Taxation contact your preparer?   YES
                                   Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908

                                                                                                                                               Rev 10/2021