Form DR-308 Request and Certificate for Waiver and Release of Florida Estate Tax Lien R.10/09

(Personal representative or attorney for estate) (Personal representative) (Print name of personal representative) City state ZIP Complete the entire form Enter the decedent s social security number (SSN) in the space provided on page 3 List the values of the estate Send a check payable to the Florida Department of Revenue for the full amount of tentative tax due Sign both pages in the space provided Submit in duplicate Title Date *Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida s taxes SSNs obtained for tax administration purposes are confidential under sections 213 053 and 119 071 Florida Statutes and not subject to disclosure as public records Collection of your SSN is authorized under state and federal law Visit our Internet site at www myflorida com/dor and select Privacy Notice for more information regarding the state and federal law governing the collection use or release of SSNs including authorized exceptions 5050 W Tennessee St Bldg L Address Attention Authorized Department signature Certificate: The estate tax lien for the above named estate has been duly discharged or duly provided for and I issue this certificate waiving and releasing the lien of the State of Florida imposed by Chapter 198 Florida Statutes on the above described property City/State/ZIP County and state of domicile Mailing address (cont ) Date of death Date of death Mailing address DR 308 DR 308 Effective 06/10 Estimated taxable estate for federal estate tax purposes $ Filing Tips Florida Administrative Code Florida Department of Revenue For a written reply to tax questions write: For Information and Forms I the undersigned do hereby state under penalties of perjury that I have read If tax is due on this estate the personal representative must pay the amount of tax due or secure the payment of the tax due along with the completed DR 308 The personal representative is liable for any tax due not paid prior to the transfer or distribution or additional tax that may be determined to be due after this request is approved Information and forms are available on our Internet site at Information for Personal Representatives Legal description of property as shown on deed (additional space on back of form) Legal description of property as shown on deed (attach additional sheets if necessary) Mail to: Name of decedent Name of decedent Name of personal representative NOT VALID UNLESS DEPARTMENT OF REVENUE SEAL IS IMPRINTED Page 2 Page 3 Page 4 Persons with hearing or speech impairments may call the TDD line at 800 367 8331 or 850 922 1115 Please mail the waiver and release certificate to: Please print or type This information will be used to mail document Please submit in duplicate PO Box 6460 R 10/09 R 10/09 Remember to: Request and Certificate for Waiver and Release of Florida Estate Tax Lien Rule 12C 3 008 Signature Date Social Security Number (SSN)* Tallahassee FL 32399 0112 Tallahassee FL 32399 6460 Taxpayer Services The personal representative agrees to furnish the Florida Department of Revenue with a copy of the federal estate tax return [Form 706 United States Estate (and Generation Skipping Transfer) Tax Return ] this document and the information stated in it is true [ss 92 525(1)(b); 213 37; 837 06 F S ] this document and the information stated in it is true [ss 92 525(1)(b); 213 37; 837 06 Florida Statutes (F S )] This request is for issuance of a certificate releasing the lien for estate tax on the property described below belonging to or forming part of the gross estate of the decedent identified below To speak with a Department of Revenue representative call Taxpayer Services Monday through Friday 8 a m to 7 p m ET at 800 352 3671 Total gross value of decedent s estate $ Under Florida law the personal representative is liable for tax due from the estate to the state of Florida Value of all other property having tax situs in Florida $ Value of Estate Value of property to be released $ Value of remaining real property in Florida if release is issued $ www myflorida com/dor