Form INH-302 State Inheritance Tax Return (Short Form)

11 TOTAL (enter on front Line 2) $ Age of Decedent County of Residence No (If Yes attach a copy to the return) and Date of Death Phone ( ) Social Security No Yes Off 10 TOTAL (enter on front Line 1) $ 12 Total Property Value 13 One half ( ) of Line 12 $ 14 Total Property Value 15 Total of lines 13 & 14 (enter on front Line 3) $ 16 Total Gifts 17 Gift Tax Paid (enter total of State Gift Tax paid on above gifts) 18 Total of lines 16 & 17 (enter on front Line 4) $ 19 TOTAL AMOUNT ALL DEDUCTIONS (enter on front Line 8) $ 302INSTRUCTIONS Acct No Address (street city state zip code) Address (street city state zip code) Attorney Representing Estate Address (street city state zip code) Preparer of Return Allowable Exemption Date of Death Did decedent have a will? Date of Valuation of assets (check one): Value of assets at date of death Description Amount DUE DATE: The return is due nine (9) months after the date of the decedent's death unless an extension of time is granted by the Department Examples: funeral & burial expenses administrative expenses (court costs bonds etc ) professional fees (attorney accountant etc ) taxes (property individual etc ) notes & mortgages due (decedent obligations but only of joint obligations) debts of decedent (unpaid at date of death) bequests (public charitable religious & educational) marital deductions (list all property passing to spouse) etc FILING THE SHORT FORM: If the gross estate of a resident decedent is less than the single exemption allowed by T C A Section 67 8 316 the representative of the estate may file the Short Form Inheritance Tax Return In the case of resident decedent's dying between January 1 1990 and June 30 1998 the allowable exemption is $600 000; from July 1 1998 to December 31 1998 the allowable exemption is $625 000; in 1999 the allowable exemption is $650 000; in 2000 and 2001 the allowable exemption is $675 000; in 2002 and 2003 the allowable exemption is $700 000; in 2004 the allowable exemption is $850 000; in 2005 the allowable exemption is $950 000; in 2006 and thereafter the allowable exemption is $1 000 000 FILING: Mail the return to Tennessee Department of Revenue Andrew Jackson State Office Building 500 Deaderick Street Nashville TN 37242 FOR ASSISTANCE: Contact Taxpayer and Vehicle Services Division by calling in state toll free 1 800 342 1003 or (615) 253 0600 FOR OFFICE USE ONLY Signature of Personal Representative Date GENERAL FILING REQUIREMENT: The Tennessee Inheritance Tax is a tax upon the privilege of receiving property by transfer because of a decedent's death The personal representative or person(s) in possession of property of the decedent is required to file a return of the estate with the Department of Revenue If spouse is deceased enter Name Personal Representative's Name (executor etc ) IF THE GROSS ESTATE (Line 5 above) IS LESS THAN THE EXEMPTION TOTAL (Line 6 above) YOU MAY USE THIS SHORT FORM INTERNET (8 11) Jointly Owned Property (Total from Schedule C reverse side) List all transfers made by decedent within 3 years prior to date of death Description of Transfer To Whom (name) Date of Gift Full Value List property interest held jointly by decedent and spouse Description Full Value List property interests held jointly by decedent and persons other than spouse Description % owned by Decedent Name of Joint Owner Full Value Owned by Decedent Name of Decedent (deceased person) NET ESTATE (subtract Line 8 from Line 7) OffOff or Value of assets 6 months after date of death Personal and Miscellaneous Property (Total from Schedule B reverse side) Real Estate (Total from Schedule A reverse side) ROUND TO THE NEAREST DOLLAR DOLLARS CENTS SCHEDULE A REAL ESTATE Individually owned and located in Tennessee Description & Location Full Value SCHEDULE B PERSONAL & MISC PROPERTY Cash Notes Mortgages Life Insurance Stocks Bonds Annuities Furnishings Automobiles Jewelry etc Owned Individually Description Full Value SCHEDULE C (PART 1) JOINTLY OWNED PROPERTY SCHEDULE C (PART 2) JOINTLY OWNED PROPERTY SCHEDULE D TRANSFERS DURING DECEDENT'S LIFE SCHEDULE E DEDUCTIONS SCHEDULES SHORT FORM INHERITANCE TAX RETURN AMENDED RETURN Signature of Preparer Date Date Received RV R0001702 TENNESSEE DEPARTMENT OF REVENUE Off TOTAL DEDUCTIONS (from Schedule E) Total Gross Estate (Add lines 1 through 4) TOTAL GROSS ESTATE (from Line 5) Transfers during decedent's life (Total from Schedule D reverse side) Under penalties of perjury I declare this report to be true accurate and complete to the best of my knowledge