Indiana Affidavit of Transferee of Trust Property that No Indiana Inheritance or Estate Tax is Due on the Transfer

Affidavit of Transferee of Trust Property that No Indiana Inheritance or Estate Tax is Due on the Transfer
Form IH-TA
Form IH-TA
State Form 48832
(R3 / 2-19)

STATE OF INDIANA				)
						)SS:
COUNTY OF ________________________ )
IN THE MATTER OF THE ESTATE OF		
)	
							)
_____________________________, DECEASED.	)

Social Security Number ______ - ___ - ______

AFFIDAVIT OF TRANSFEREE OF TRUST PROPERTY THAT NO
INDIANA INHERITANCE OR ESTATE TAX IS DUE ON THE TRANSFER
	

Comes now ___________________, being first duly sworn upon his/her oath, says that:

1. Transferee, ___________________________________________________, is a trust beneficiary, successor
trustee (strike inappropriate terms) of the _____________________________________ Trust, under agreement
dated and signed on the ____ day of _______________, 20______ and last amended on the ____ day of
(month)
(year)
______________, 20______.
(month)

(year)

2. That the original grantor_____________________, of the trust died on the ____ day of ______________,
(month)
20______, a resident of ___________________, County, Indiana.
(year)

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	

Account Number	

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

)
) 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: ______________________

NOTE: This affidavit must immediately be filed with the Indiana Department of Revenue, Inheritance Tax Division,
P.O. Box 71, Indianapolis, Indiana 46206-0071.