Vermont Department of Taxes     133 State Street     Montpelier, VT  05633-1401
Phone:  (802) 828-6820
                                                                                                *23E2A1100*
     Form
                      ESTATE TAX INFORMATION AND 
                                                                                                *23E2A1100*
     E2A              APPLICATION FOR TAX CLEARANCES                                                                                        Page 3
Decedent’s Information
            Decedent’s Last Name                                 First Name             Initial      Decedent’s Social Security Number

                            Address of Residence (domicile) at Time of Death                    Spouse’s/CU Partner’s Social Security Number

                      City                       State                         ZIP Code         Date of Death (mm/dd/yyyy) Age at Death
                                                                                                     /        /
Administrator / Executor / Trustee Information
                                 Administrator / Executor / Trustee Name                             Telephone Number

                                                 Mailing Address                                     For Department Use Only

                      City                       State                         ZIP Code

            Foreign Country                                                             Email Address
                                                                                                                                            FORM  (Place at FIRST page)
                                                                                                                                            Form pages 
Attorney Information
                                                 Attorney’s Name                                     Telephone Number

                                                 Mailing Address                                     For Department Use Only
                      City                       State                         ZIP Code                                                     3 - 3

            Foreign Country                                                             Email Address

  1. Has the estate been entered in Probate Court? .......                 Yes, District ____________________________        No

Section A   VERMONT INCOME TAX (see instructions)  Is a Vermont Income Tax Return required for Year of Death?
           Yes.  A return must be filed before the tax clearance can be issued.
           No.  State reason  _______________________________________________________________________

Section B   VERMONT FIDUCIARY TAX (see instructions)  If income is received by the estate during administration, Fiduciary 
     Tax Returns may be due.  Check appropriate box.  FEIN (required):  _____________________________________
           No returns are                         Required returns                      Final required returns will be filed by 
            required to be filed.                 have been filed.                       (mm/dd/yyyy) ___________________/        /

Section C   VERMONT ESTATE TAX (see instructions)  
     For deaths BEFORE 2009:  Is a U.S. Estate Tax Return, Form 706, required to be filed?                                                  FORM  (Place at LAST page)
                                                                                                                                            Form pages 
     For deaths in 2009 or 2010:  Is the total value of the gross estate, including taxable gifts, more than $2,000,000.00*?  
    For deaths in 2011 through 2019:  Is the total value of the gross estate, including taxable gifts, more than $2,750,000.00*?
    For deaths in 2020:  Is the total value of the gross estate, including taxable gifts, more than $4,250,000.00*?
    For deaths in or after 2021:  Is the total value of the gross estate, including taxable gifts, more than $5,000,000.00*?
           Yes.  A Vermont Estate Tax Return is required to be filed.                                                                      3 - 3
           No.  A Vermont Estate Tax Return is not required to be filed.
            *The Total Value of an estate at time of death includes jointly owned assets, solely owned assets, 
            insurances with or without named beneficiaries and trust assets, etc.  For an ancillary estate this 
            figure includes the value of the other states assets as well as the value of the Vermont assets.
I certify that the information contained herein is true, correct, and complete to the best of my knowledge.
                                                                                                                           Form E2A
                                                                                                                           Page 1 of 1
     Signature of Administrator/Executor/Trustee                 Printed Name                   Date                       Rev. 01/23

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