IT: EST-123
                     ALABAMA                    DEPARTMENT OF REVENUE                                        9/01
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                                               ESTATE TAX ECTIONS
                                P.O. Box 327440, Montgomery, AL 36132-7440

             Application for Refund of Estate Tax
    Paid Through Mistake or Error to the Alabama Department of Revenue

TO: ALABAMA DEPARTMENT OF REVENUE
    MONTGOMERY, ALABAMA

Under the provisions of Section 40-15-21, Code of Alabama 1975, application is hereby made for a refund of estate tax in
the amount of $______________________ and such additional amount as may be determined by the Alabama Department of
Revenue paid by the said applicant through mistake or error to the Department of Revenue, said amount having been paid
on the date or dates as follows: __________________________________________________________________________________
______________________________________________________________________________________________________________

The facts in support of this application and the cause for alleged overpayment are briefly stated as follows:

                                                      ________________________________________________________
                                                      ESTATE  (TYPE OR PRINT)

                                                      ________________________________________________________
                                                      APPLICANT

                                                      ________________________________________________________
                                                      MAILING ADDRESS

                                                      ________________________________________________________
                                                      CITY                             STATE ZIP

                                                      ________________________________________________________
                                                      SIGNATURE

Sworn to and subscribed before me this the ____________ day of _____________________________________, 20_______ .

______________________________________________________
NOTARY PUBLIC

TO: STATE COMPTROLLER
    MONTGOMERY, ALABAMA

I, _____________________________________________________ , Assistant Commissioner of the Alabama Department of
Revenue, do hereby certify that the above application for refund has been examined and that estate tax in the amount of
$_______________________ was paid by the applicant to the Alabama Department of Revenue as above stated. As
authorized by Section 40-15-21, Code of Alabama 1975, it is requested that you draw your warrant on Estate Tax Fund in
favor of the above named applicant for the sum of _________________________________________________________________
___________________________________________________ Dollars ($_______________________), which is the amount of said
estate tax erroneously paid to the Alabama Department of Revenue, plus interest at the legal rate as provided by law from
___________________________________________________________________________________________ , date(s) of payment.

This ___________ day of _____________________________ , 20_________ .

APPROVED FOR PAYMENT:

_____________________________________________________
DIRECTOR, INDIVIDUAL AND CORPORATE TAX DIVISION

                                                      ________________________________________________________
                                                      ASSISTANT COMMISSIONER OF REVENUE

Received of State Comptroller, his Warrant No. ____________________ for ______________ in full payment of the above.

                                                      ________________________________________________________
Prepare This Form In Triplicate.  Send Two Copies To The Alabama Department of Revenue At The Address Above.  Retain One Copy For Your Records.