Enlarge image | Department of Taxation and Finance For office use only New York State Estate Tax Certification ET-85(7/20) For an estate of an individual whose date of death is on or after January 1, 2019 Decedent’s last name First name Middle initial Social Security number (SSN) Address of decedent at time of death (number and street) Date of death Mark an Xif copy of death certificate is attached (see instr.) City State ZIP code County of residence If the decedent was a nonresident of New York State on the date of death, mark an Xin this box and attach a completed Form ET-141, New York State Estate Tax Domicile Affidavit. Power of Attorney – Mark an Xin the box if Form ET-14,Estate Tax Power of Attorney, isattached (see instructions) If Form ET-14 was previously provided, indicate which form it was attached to and the date it was submitted: Form Date Executor – If you are submitting Letters Testamentary or Letters of Administration with this form, indicate in this box the type of letters. Enter Lif regular, LL if limited letters. If you are not submitting letters with this form, enter N. ............. Attorney’s or authorized representative’s last name First name MI Executor’s (for definition, see instr.) last name First name MI In care of (firm’s name) If more than one executor, Email address of executor mark an Xin the box (see instr.) Address of attorney or authorized representative Address of executor City State ZIP code City State ZIP code SSN or PTIN of attorney or authorized rep. Telephone number Social Security number of executor Telephone number ( ) ( ) Estimated net estate (including jointly held assets) Were releases of lien previously issued? ............... Yes No 1Real property .................................... 1 2 Bank deposits, mortgages, notes and cash 2 If Yes, give date of issuance (mm-dd-yyyy). 3 Stocks and bonds ............................. 3 Was the decedent a member of a partnership? ...... Yes No 4 Life insurance ................................... 4 5 Annuities ........................................... 5 Did the decedent have a surviving spouse?............ Yes No 6 Retirement benefits .......................... 6 If the decedent was a nonresident of New York 7 Miscellaneous assets State, does the estate include real property or (such as cars, boats, and coin collections) 7 tangible personal property having an actual 8 Taxable gifts (see instructions) ............ 8 situs in New York State?.......................................... Yes No 9 Includible QTIP Property (see instr.) .. 9 10 Estimated litigation awards (see instr.) 10 11 Add lines 1 through 10........................ 11 12 Estimated deductions ......................... 12 13 Estimated net estate (subtract line 12 from line 11) 13 Mark an Xin the box below if a release of lien is requested. Releases of lien are requested – Submit a separate Form ET-117, Release of Lien of Estate Tax, for each county, cooperative housing corporation, and purchaser (see instructions). A release of lien is not required if the property was held jointly by the decedent and the surviving spouse as the only joint tenants. There is no fee for a release of lien. If releases of lien are required, enter the total number of counties here .................... Executor or applicant, be sure to sign this return on page 2. If an attorney or authorized representative is listed on this return, he or she must complete the following declaration. I declare that I have agreed to represent the executor(s) for the above estate, that I am authorized to receive tax information regarding the estate, and I am (mark an Xin all boxes that apply): an attorney a certified public accountant an enrolled agent a public accountant enrolled with the New York State Education Department Signature of attorney or authorized representative Date 00300107200099 |
Enlarge image | Page 2 of 2 ET-85 (7/20) State of , County of , Certification: The undersigned states that he or she is the duly appointed executor or administrator, or a beneficiary or person having an interest in the above named estate for which no executor or administrator Sworn to before me this day has been appointed and agrees to provide written evidence of such interest or authority upon request. The undersigned further states that he or she has a thorough knowledge of the decedent’s assets. This certification of , estimates the assets of the decedent’s estate, and the answers to the above questions are each and every one of them true in every particular. The certification is made to induce the Commissioner of Taxation and Signature of Notary Public, Commissioner of Deeds, Finance to give a release of lien required by the Tax Law. or authorized New York State Department of Taxation Signature of executor/applicant and Finance employee (affix stamp below) Mark an Xin the applicable box: Attorney Court appointed Executor Power of Attorney Other (specify role) Mail to: NYS ESTATE TAX, PROCESSING CENTER, PO BOX 15167, ALBANY NY 12212-5167. 00300207200099 |