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                                                        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



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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






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