File No.
(TYPE OR PRINT IN BLACK INK)

STATE OF NORTH CAROLINA                                                                                                In The General Court Of Justice
                                                                                                                              Before the Clerk
                                                  County

            IN THE MATTER OF THE ESTATE OF:
Name Of Decedent
                                                                                                 ESTATE TAX CERTIFICATION
Date Of Death 
                                                                                                 (FOR DECEDENTS DYING ON OR AFTER 1/1/99)
Decedent's Social Security Number (Last Four Digits) 
                                                                                                                                             G.S. 28A-21-2; -25-3;105-32.2
NOTE: Use this form for decedents dying on or after 1/1/99.  For decedent's dying before 1/1/99, use AOC-E-207.
I, the personal representative/fiduciary/spouse in the above estate, certify that:
     1.       a. The gross value of the estate prior to the date of the decedent's death is less than: 
                 $650,000 (If decedent died on or after 1/1/1999).                               $1,500,000           (If decedent died on or after 1/1/2004).
                 $675,000 (If decedent died on or after 1/1/2000).                               $2,000,000           (If decedent died on or after 1/1/2006).
                 $1,000,000 (If decedent died on or after 1/1/2002).                             $3,500,000           (If decedent died on or after 1/1/2009).
              b. The decedent died on or after 1/1/2010, and there is no federal estate tax due or payable.

     2. The decedent died on or after 1/1/2013, and therefore, no North Carolina estate tax is due or payable.

     3. I am the surviving spouse and sole heir of the decedent.

Date                 Signature                                                              Date                  Signature

Title Of Personal Representative/Fiduciary/Spouse                                           Title Of Personal Representative/Fiduciary/Spouse

Address Of Personal Representative/Fiduciary/Spouse                                         Address Of Personal Representative/Fiduciary/Spouse

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME                                                  SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date             Signature Of Person Authorized To Administer Oaths                         Date                  Signature Of Person Authorized To Administer Oaths

     Deputy CSC                    Assistant CSC                    Clerk Of Superior Court      Deputy CSC                       Assistant CSC                   Clerk Of Superior Court
                     Date My Commission Expires                                             Date My Commission Expires
     Notary                                                                                                                                    Notary
                     County Where Notarized                                                 County Where Notarized
     SEAL                                                                                                                                      SEAL

NOTE TO PERSONAL REPRESENTATIVE/FIDUCIARY/SPOUSE AND CLERK:
No final accounting of an estate may be approved unless the personal representative files with the Clerk of Superior Court an Estate 
Tax Certification, AOC-E-212, or a certificate issued by the Secretary of Revenue stating the estate tax liability has been satisfied. 
G.S. 105-32.3(c).

                                                        Original-File    Copy-Taxpayer
AOC-E-212, Rev. 8/13 
© 2013 Administrative Office of the Courts