Print Reset
RV-R0001602 INTERNET (2-15)
INH TENNESSEE DEPARTMENT OF REVENUE
301 INHERITANCE TAX RETURN AMENDED RETURN
____ ____ ____ - ____ ____ - ____ ____ ____ ____
DATE OF DEATH COUNTY OF TN PROBATE DECEDENT'S SOCIAL SECURITY NUMBER
This return should be used for estates of dece-
NAME OF DECEDENT Last: First: MI: ____ dents whose date of death is on or after Janu-
ary 1, 1990. This return is due nine (9) months
ADDRESS (AT TIME OF DEATH) ____________________________________________ after the date of the decedent's death, unless
an extension of time is granted by the Depart-
______________________________________________________________________ ment. Please print in blue or black ink.
CITY: State: ZIP CODE: __________ Make your check payable to the Tennessee
Department of Revenue for the amount shown
on Line 10 and mail to:
Yes No Tennessee Department of Revenue
Andrew Jackson State Office Building
Election of Alternate Valuation _________ _________ 500 Deaderick Street
Election of Special Use Valuation _________ _________ Nashville, Tennessee 37242
Gross Estate contains T.C.A. ยง67-8-304 (10) (QTIP) property ________ _________ For assistance, you may call in-state toll free
1-800-342-1003 or (615) 253-0600.
Age of Decedent ________ Did decedent have a will? Yes No (If Yes, attach a copy to the return).
Personal Representative's Name (executor, etc.) Last Name: First Name: MI: ___
Address Street: City: State: Zip Code: _________
Personal Representative's Name (executor, etc.) Last Name: First Name: MI: ___
Address Street: City: State: Zip Code: _________
Return Preparer: Last Name/Firm: First Name: MI: Phone ____________
Address Street: City: State: Zip Code: _________
Attorney For the Estate Last Name/Firm: First Name: MI: Phone:
Address Street: City: State: Zip Code: _________
ROUND TO THE NEAREST DOLLAR
Dollars Cents
COMPUTATION OF AMOUNT DUE
1. Inheritance Tax ...................................................................................................................... _________________________00
2. Deduct: Applicable Credits ..................................................................................................... _________________________00
3. Inheritance Tax Payable (Line 1 minus Line 2) ....................................................................... _________________________00
4. Tennessee Estate Tax ........................................................................................................... _________________________00
5. Total Taxes Due (Add Lines 3 and 4)...................................................................................... _________________________00
6. Deduct: Extension Payments................................................................................................. _________________________00
7. Balance of Tax Due (Line 5 minus Line 6) .............................................................................. _________________________00
8. Penalty (5% for each 30-day period of delinquency not to exceed 25% of the tax due) ........... _________________________00
9. Interest (________% per annum on any taxes unpaid by the due date) .................................. _________________________00
10. Total Amount Due (Add Lines 7, 8, and 9).......................................................................... 00
Under the penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and FOR OFFICE USE ONLY
belief, it is true, correct and complete.
Personal Acct. #____________________
Representative's
signature __________________________________________ Date ______________
Date Rec'd ________________
Preparer's
signature __________________________________________ Date ______________ Amt. Rec'd $ _______________
Page 1