Indiana Affidavit of No Inheritance Tax Due

Affidavit of No Inheritance Tax Due
IH-Exem (04-09).indd
IH-Exem

State Form 48831
(R4 / 5-14)

Not for Public Access*
AFFIDAVIT OF NO INHERITANCE TAX DUE

STATE OF INDIANA	

)	

	

) SS:

IN THE_______________________COUNTY______________ COURT

COUNTY OF __________________ )	

CAUSE NO.________________________________________

In the Matter of the Estate of:_______________________________________________ , deceased.
Address of Decedent:_____________________________________________________
	

_____________________________________________________

County of Decedent’s Residence:____________________________________________
Social Security Number of Decedent:_________________________________________
Date of Decedent’s Death:_________________________________________________
	I, _____________________________________ (name of affiant), being duly sworn upon my oath, state
that: I am familiar with the facts set out in this affidavit as the_______________________ (state relationship of
affiant to Decedent or Decedent’s estate) of Decedent or Decedent’s estate. No inheritance tax is due by reason
of Decedent’s death because no transferee receives taxable transfers in excess of such transferee’s exemption
from inheritance tax as listed herein.
	

Following is a complete listing of all transfers subject to inheritance tax by reason of Decedent’s death

(enclose additional pages as necessary):
	

Description of Property	

Manner of Transfer	

Date of Death Value

		______________________________ 	

_________________________ 	

__________________________

	 ______________________________ 	

_________________________ 	

__________________________

	 ______________________________ 	

_________________________ 	

__________________________

	 ______________________________ 	

_________________________ 	

__________________________

	 ______________________________ 	

_________________________ 	

__________________________

	 ______________________________ 	

_________________________ 	

__________________________

Total Value of All Taxable Transfers by Decedent (Gross Estate)	

__________________________

(-) Less total expenses of decedent/estate**	

__________________________

(=) Taxable estate	

__________________________

* Once completed, this form is confidential pursuant to Ind. Code § 6-4.1-12-12. To comply with Trial Rule 5(G), this form is marked
“Not for Public Access” and is required to be filed on light green paper if it is filed for an otherwise public estate.
** Enclose an itemized list of deductions. See, Ind. Code § 6-4.1-3-13.

Following is a complete listing of the transferees of Decedent’s taxable transfers and the value of such transfers
(attach additional pages as necessary):
Name of Transferee	

Relationship to Decedent	

Value of Transfer(s)	

Exemption

	 ___________________ 	

_____________________	

____________________ 	

________________

	 ___________________ 	

_____________________	

____________________ 	

________________

	 ___________________ 	

_____________________	

____________________ 	

	 ___________________ 	

Not
for Public
Access* 	
_____________________	
____________________

________________

	 ___________________ 	

_____________________	

____________________ 	

________________

	 ___________________ 	

_____________________	

____________________ 	

________________

________________

Total Value of All Taxable Transfers by Decedent
Dated:______________________________ 	

Signature:___________________________

Name of Lawyer:______________________ 	

Printed:_____________________________

Address:____________________________ 	Address:____________________________
	

___________________________ 	

____________________________

Telephone:___________________________
STATE OF INDIANA			
)
					) SS:
COUNTY OF___________________ )
Before me, a Notary Public in and for ____________________ County, State of _______________________ ,
personally appeared _________________________________ , who acknowledged execution of the foregoing
document and who, being duly sworn, stated the representations contained herein to be true.
	
	
WITNESS my hand and Notarial Seal this___________day of ____________ ,__________________ .
							
	
(Signature)__________________________________
							
	
(Printed)___________________________________
											
Notary Public

SEAL

My commission expires: ___________________

Instructions for Completing
Use of Affidavit of No Inheritance Tax Due
This form does not need to be completed for those individuals dying after Dec. 31, 2012. For those
individuals dying before Jan. 1, 2013, this form may need to be completed.
This form is prescribed under Ind. Code § 6-4.1-4-0.5. It may be used to state that no inheritance tax is due as
a result of Decedent’s death after application of the exemptions provided by Ind. Code § 6-4.1-3,et seq. The
affidavit may be used only for a decedent whose taxable transfers to each transferee are less than that transferee’s
exemptions. If transfers to any transferee exceed that transferee’s exemption, this affidavit is not available.
All of the property transferred by the Decedent by taxable transfers should be included in the list of taxable transfers
herein with the property described, with the nature of the transfer described, and with the date of death value of
the transferred property listed. If real property transfers are included, the legal description of the property should
be included. Use attachments if necessary for such descriptions.
Each recipient of taxable transfers by Decedent should be listed by name with the transferee’s relationship to
Decedent, the total value of property transferred by Decedent to him or her, and the amount of the transferee’s
exemption. Allowable exemptions are unlimited for Decedent’s surviving spouse and for qualified charitable entities.
See Ind. Code §§ 6-4.1-3-10 through 6-4.1-3-12 for specific exemption amounts.
If real estate is included in the property subject to taxable transfers by Decedent, the affidavit may be recorded
in the office of the county recorder. The affidavit must include the legal description of such real property to be so
recorded. The SSN must be redacted in order to be recorded.
If Ind. Code § 6-4.1-8-4 requires consent to transfer personal property listed on this affidavit, the affidavit may
be submitted to the county assessor to establish that consenting to such transfer will not jeopardize collection of
inheritance tax.
Recording this affidavit with the county recorder will terminate the statutory lien on such real estate for inheritance
tax. Similarly, submission of the affidavit to the county assessor in the Decedent’s county of residence discharges
the lien on personal property for inheritance tax. Such liens may be reattached if the department obtains an order
that inheritance tax is owed.