Affidavit Of Transferee Of Trust Property That No Indiana Inheritance Or Estate Tax Is Due On The Transfer {IH-TA}

IH-TA(3-98) SF# 48832 STATE OF INDIANA COUNTY OF IN THE MATTER OF THE ESTATE OF ) )SS: ) ) ) ) , DECEASED. AFFIDAVIT OF TRANSFEREE OF TRUST PROPERTY THAT NO INDIANA INHERITANCE OR ESTATE TAX IS DUE ON THE TRANSFER Comes now 1. Transferee (strike inappropriate terms) of the day of 2. That the original grantor, stated trust died on the , being first duly sworn upon his/her oath, says that: , is a trust beneficiary, successor trustee Trust, under agreement dated and signed on the and last amended on the day of , 19 , whose social security number is , 19 , a resident of , of the above , County, Indiana. , , 19 . day of 3. Transferee (a) is domiciled in Indiana, or (b) is a representative of a corporation doing business in Indiana. (Strike either (a) or (b), whichever is not pertinent.) 4. That the following personal property sought to be transferred is held by the trust: Holding Institution Description of Property Date of Death Value 5. That the transfer of the trust personal property is not subject to Indiana inheritance or estate tax for the following reason: 6. Transferee, by making this affidavit, says that the above trust personal property will be transferred to him/her and is not subject to Indiana inheritance or estate tax and further says, under the penalties for perjury, that the statements herein are true and correct to the best of such person's knowledge and belief. Signature of transferee Name (typed or printed) Address STATE OF INDIANA COUNTY OF ) )SS: ) day of Subscribed and sworn to under penalties for perjury before me, a Notary Public in and for said County and State, this , 19 . Signature Printed My Commissions Expires: Residing in County, Indiana. NOTE: This affidavit must immediately be filed with the Indiana Department of Revenue, Inheritance Tax Division, P.O. Box 71, American LegalNet, Inc. Indianapolis, IN 46206-0071. www.FormsWorkflow.com