Kentucky Inheritance Tax Return - No Tax Due

Inheritance Tax Return - No Tax Due
Form 92A201
92A201 (6-16)

Kentucky Inheritance
Tax Return

Commonwealth of Kentucky
DEPARTMENT OF REVENUE

NO TAX DUE

FOR DEPARTMENT USE ONLY

	 
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Account Number	
Tax	
Mo	
Year

This return may be used if: (1) there is no Kentucky inheritance tax due, (2) the date of death is on or after January 1, 2005, and
(3) the entire estate passes to beneficiaries listed in the following groups either by contract (survivorship, payable on death, trust,
etc.), the decedent’s will, or the intestate laws of this state:
(1)	 Surviving spouse, parent
(2)	 Child (adult or infant)
		
child by blood, stepchild, child adopted during infancy,
		
or a child adopted during adulthood who was reared by decedent during infancy
(3)	Grandchild
		
issue of child by blood, stepchild, child adopted during infancy,
		
or of a child adopted during adulthood who was reared by decedent during infancy
(4)	 Brother, sister (whole or half)
		
➤  Refer to KRS 140.080 for (1) through (4) above
(5)	 Exempt organizations—Refer to KRS 140.060
	
	
Exempt organizations include educational, religious or other institutions, societies, or associations, whose sole purpose
is to carry on charitable, educational, or religious work. Also, cities, towns or public institutions in this state qualify as
exempt organizations provided that any transfer to such an organization is for public purposes.
	 Decedent’s Name	 Last	

First	

Middle Initial	 Date of Death

	 Social Security Number	 Occupation (If decedent was retired Age at Death	
at death, state occupation prior to
retirement.)

Cause of Death	

HR Code Number (if known)

	
	 Residence (Domicile) at Time of Death

	

Number and Street	

City	

	 Name and Address of Executor/Administrator/Beneficiary	
 

State	

 Exec

 Atty

 Admr

 CPA

 ________

 ________

		

ZIP Code	

County

Name and Address of Preparer

Did the decedent have a will?   No   Yes  If Yes, attach a copy of the will.
Did the decedent have a trust agreement?   No   Yes  If Yes, attach a copy of the trust agreement.
				

Filing status of Federal Estate and Gift Tax Return for this estate (check one):
  Not Required    Required (enclose copy)    Not Required, but filed for Portability (enclose copy)   
Schedules for listing property (real and personal) and beneficiaries are on the reverse side of this form. Listing of
property is optional. Listing of beneficiaries and their relationship is required.
Total Value of Property from Reverse Side ..........................................(optional) ➤	$

	

✍

Under criminal penalties, I declare that this return, including accompanying documents, has been examined by me, and
is, to the best of my knowledge and belief, true, correct and complete.

 (  )
	

Signature of Executor/Administrator/Beneficiary	

Date	

Telephone Number	

E-mail Address

 (  )
	

Signature of Preparer	

 

Date	

Telephone Number	

Mail to: Kentucky Department of Revenue, Frankfort, Kentucky 40620

E-mail Address

92A201 (6-16)

PART I—PROPERTY (Optional Listing)
	

	

	

Description and Location	
of Real or Personal Property	

Fair Cash Value
at Date of Death

Total Value of Property .................................................................................. ➤	

$

PART II—BENEFICIARIES (Must be completed)
	

Name of Beneficiary	

Relation to Decedent (Required)

If all taxable assets pass to exempt beneficiaries and a Federal Estate and Gift Tax Return is not filed, it is not
necessary to file an Inheritance Tax Return with the Kentucky Department of Revenue. An affidavit of exemption will
be accepted by the courts for the final settlement and closing of the administration of an estate. If inheritance tax is
due the Commonwealth of Kentucky, Form 92A200 or 92A205 should be used.