Indiana Inheritance Tax Return For A Non-Resident Decedent {IH-12}

Prescribed by the Indiana Department of State Revenue Form IH-12 SF # R1 8-04 INDIANA INHERITANCE TAX RETURN FOR A NON-RESIDENT DECEDENT NOTE: Please read carefully the general instructions before preparing this return. Decedent's name Decedent's residence (domicile) at time of death Address of decedent at time of death Name of ancillary administrator or executor Location of court Business or occupation Social Security number Did the decedent die testate? YES If yes, attach copy of will NO Date of death Address of ancillary administrator or executor Name, address and phone number of attorneys representing estate Gross value of entire estate, wherever situated: Amount $ Is a Federal Estate Tax Return required to be filed with the IRS? YES NO If yes, attach a copy Schedule A attached hereto discloses all interests of decedent in Indiana real estate and sets forth the information called for in the heading of said schedule. Schedule B attached hereto discloses all tangible personal property of decedent which had an actual situs in this state, as called for in the heading of said schedule. Schedule C attached hereto discloses all information respecting gifts, transfers and trusts as called for in the heading of said schedule. Schedule D attached hereto sets forth all allowable deductions in connection with the settlement of the non-resident decedent's estate in Indiana. Schedule E attached hereto discloses the requested information concerning the persons beneficially interested in the property taxable in this state. I have made a due and diligent search for property of every kind, nature and description left by the decedent within the jurisdiction of this state and have been able to discover only that set forth in Schedules A, B and C. No information of any other property of the decedent has come to my knowledge, and I verily believe that the decedent left no property except as therein set forth. Subscribed and sworn to before me this (Signature) day of A.D. , (Capacity) (Officer) (P.O. Address) American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE A REAL ESTATE Did the decedent, at the time of his or her death, own any real estate in Indiana? YES Description No. of Acres Value Last Assessed for Taxation NO Fair Market Value at Date of Death TOTAL SCHEDULE A American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE B TANGIBLE PERSONAL PROPERTY Did the decedent, at the time of his or her death, own tangible personal property which had an actual situs in this state? YES Description NO Fair Market Value at Date of Death TOTAL SCHEDULE B American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE C TRANSFERS DURING DECEDENT'S LIFE Did the decedent, at any time during his or her life, make any transfers in contemplation of death? Did the decedent, within one (1) year immediately preceding his or her death, make any transfers of property for less than an adequate and full consideration in money or money's worth? Did the decedent, at any time during his or her life, make a transfer of property for less than an adequate and full consideration in money or money's worth in which he or she retained a life estate, the right to income or some other interest? Were there in existence at the time of decedent's death any trusts, created by him or her or others, in which he or she had an interest? If yes, attach copy of trust or trusts? YES NO YES NO YES NO YES NO NOTE: If any transfers made within one (1) year immediately preceding the decedent's death for less than an adequate and full consideration are claimed not to have been made in contemplation of death, submit proof. If any of the above are answered "YES" describe below. Date of Transfer, Description of Property Transferred and Means of Transfer Fair Market Value at Date of Death Less Consideration Received TOTAL SCHEDULE C American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE D DEDUCTIONS List only deductions claimed and allowed against the property taxable in this state. (For allowable deductions, see the general instruction) Nature and Description of Deductions Claimed Amount of Deductions Claimed TOTAL SCHEDULE D RECAPITULATION Total taxable assets SCHEDULE A SCHEDULE B SCHEDULE C TOTAL LESS DEDUCTIONS (SCHEDULE D) TOTAL TAXABLE ESTATE American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE E PERSONS BENEFICIALLY INTERESTED IN THIS ESTATE On Schedule E list only the persons beneficially interested in the property taxable in this state, showing the value of interests received by those persons in the Indiana property. List the name, address, and relationship to decedent, and whether such relationship is by blood, marriage, or adoption, of each transferee entitled to share in the estate or who received property, the transfer of which is taxable under the Inheritance Tax Law, I.C. 6-4.1. If the decedent died testate list the section of the will applicable to each testamentary transfer. List in the appropriate column the age of each transferee, the value of property transferred, the exemption, and the amount of the transfer subject to tax. Name, Address, Relationship of Transferee to Decedent and Applicable Section of Will, If Any Age Value of Property Transferred Exemption Amount Subject to Tax TOTAL VALUE OF PROPERTY TRANSFERRED American LegalNet, Inc. www.FormsWorkflow.com GENERAL INSTRUCTIONS FOR PREPARATION OF FORM IH-12 REVISED 2004 I. PROPERTY SUBJECT TO TAXATION When the transfer is from non-residents of this state, the inheritance tax is imposed and levied upon all real and tangible personal property within the jurisdiction of this state. The words real or personal property within the jurisdiction of this state, as used in the Indiana Inheritance Tax Law, include all real estate located within the state and all tangible personal property which had a situs in the state. II. DEFINITION OF TRANSFER The word transfer, as used in the Indiana Inheritance Tax Law, includes the passing of property or any interest therein in possession or enjoyment, present or future, by inheritance, descent, devise, bequest, grant, bargain or gift. The exercise of the right of survivorship in cases of joint ownership is deemed a taxable transfer in the same manner as though the whole property belonged absolutely to the deceased joint owner and had been devised or bequeathed to the survivor or survivors by will. III. DEDUCTIONS "The following items, and no others, may be deducted from the value of property interests transferred by a non-resident decedent: (1) t