Form ET-115.1:11/12:New York State Estate Tax Report of Federal

ET-115.1
New York State Department of Taxation and Finance
New York State Estate Tax Report of
Federal Audit Changes
For office use only
(11/12)
For an estate of an individual who died
on or after February 1, 2000
Decedent’s last name
First name
Middle initial
Address of decedent at time of death (number and street)
City
Social security number (SSN)
Date of death
State
ZIP code
County of residence
If the decedent was a nonresident of New York State (NYS) on the date of death, mark an X in this box and attach a
completed Form ET-141, New York State Estate Tax Domicile Affidavit, if one was not submitted previously...........................
Employer identification number (EIN) of the estate Name and EIN of any trusts created or funded by the will Executor – If there has been a change of executor and you are submitting Letters Testamentary or Letters of
Administration with this form, indicate in this box the type of letters. Enter L if regular, LL if limited letters. If you are
not submitting letters with this form, enter N........................................................................................................................
Attorney’s or authorized representative’s last name
First name MI Executor’s last name
First name
If POA is
attached,
mark an X
in the box
In care of (firm’s name)
Address of attorney or authorized representative
City
State
MI
If more than one executor, mark an X E-mail address of executor
in the box (see Form ET-706-I)
Address of executor
ZIP code
City
State
ZIP code
SSN or PTIN of attorney or authorized rep.
Telephone numberSocial security number of executor
Telephone number
( )
( )
If the decedent possessed a cause of action or was a plaintiff in any litigation at the time of death, mark an X in this
box and complete Schedule 3 (see Form ET-706-I, page 3, Litigation information) ..............................................................
Tax computation
Installment payments of tax for closely held business — Do you elect to pay the tax in installments as described
in Internal Revenue Code section 6166 (NYS Tax Law section 997)? If Yes, attach Form ET-415 (see Form ET-706-I) .... Yes
No
a Taxable estate for New York State, as adjusted (from Schedule A, line 26, or Schedule B, line 43) ............................
b Gross federal estate tax for New York State (from Schedule A, line 31, or Schedule B, line 48) ................................. 1 New York State credit for state death taxes (from Schedule A, line 36, or Schedule B, line 51) ........................... 1.
2 If there is property outside NYS that is included in the federal gross estate, see instructions on page 2;
otherwise enter 0 here and on lines 3, 5, 6, and 7, and enter the amount from line 1 on line 8.................. 2.
3 Residents enter amount from Schedule 1, line 14; nonresidents enter amount from Schedule 2, line 19 .......... 3.
4 Total gross estate, less exclusion, for New York State (from Schedule A, line 22, or Schedule B, line 39) .......... 4.
5 Divide line 3 by line 4 (round the result to the fourth decimal place). The result should not be greater than 1.0 5.
6 Multiply line 1 by the decimal on line 5 (round to nearest cents) ...................................................................... 6.
7 Enter the amount from line 6, if any; otherwise enter 0 ................................................................................ 7.
8 New York State estate tax (subtract line 7 from line 1) ...................................................................................... 8.
9 Prior tax payments to New York State, if any (attach a schedule of dates and amounts) .................................... 9.
10 If line 9 is less than line 8, subtract line 9 from line 8. This is the amount you owe .................................... 10.
11 If line 9 is greater than line 8, subtract line 8 from line 9. This is the amount to be refunded to you .......... 11.
If an attorney or authorized representative is listed above, he or she must complete the following declaration.
I declare that I have agreed to represent the executor(s) for the above estate, that I am authorized to receive tax information regarding the
estate, and I am (mark an X in all that apply):
an attorney
a certified public accountant
an enrolled agent
a public accountant enrolled with the New York State Education Department
Signature of attorney or authorized representative
Date
E-mail address of attorney
Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Furthermore, I/we, as executor(s) for this estate, authorize the person, if any, named as my/our representative on this
report to receive confidential tax information regarding this estate.
Signature of executor
Date
Signature of co-executor
Date
Firm’s name if preparer other than executor (or yours if self-employed)
Signature of preparer other than executor
Date
Address of preparer
E-mail address of preparer
City
State
ZIP code
Preparer’s PTIN or SSN
Firm’s employer identification number
Preparer’s NYTPRIN
Page 2 of 4 ET-115.1 (11/12)
Line 2 — For dates of death on or after February 1, 2000, and before January 1, 2002 — If there is property located outside New York
State that is included in the federal gross estate, and estate tax or inheritance tax is payable to another state, enter the amount that is
allowable as a federal credit. If tax is payable to more than one other state, enter the combined amount of tax payable to the other states
allowable as a federal credit. Also complete lines 3 through 7 and either Schedule 1 or 2 below.
For dates of death on or after January 1, 2002 — If there is property located outside New York State that is included in the federal gross
estate, complete lines 3 through 6 and enter the line 6 amount on lines 2 and 7. Also complete either Schedule 1 or 2 below.
Schedule 1 — Resident
List below each item of real and tangible personal property located outside New York State that is included in the federal gross estate.
Include the item number, the schedule of federal Form 706 on which it was reported, and the reported value of the property as adjusted.
Item number Description
Adjusted value
12 Total value of property listed above............................................................................................................... 12.
13 Property subject to a limited power of appointment created before September 1, 1930, includable in
the New York State gross estate under NYS Tax Law section 957, if any (see Form ET-706-I) ..................... 13.
14 Subtract line 13 from line 12; enter the result here and on line 3.................................................................. 14.
Schedule 2 — Nonresident
15 Total gross estate for New York State (from Schedule A, line 22, or Schedule B, line 39) .................................... 15.
List below each item of real and tangible personal property located within New York State. Include the item number,
the schedule of federal Form 706 or 706-NA on which it was reported, and the reported value of the property as adjusted.
Item number Description
Adjusted value
16 Total value of property listed above............................................................................................................... 17 Property subject to a limited power of appointment created before September 1, 1930, includable in
the New York State gross estate under NYS Tax Law section 957, if any (see Form ET-706-I) .................... 18 Add lines 16 and 17....................................................................................................................................... 19 Subtract line 18 from line 15; enter the result here and on line 3.................................................................. 16.
17.
18.
19.
Schedule 3 — Description of litigation or cause of action
In the area provided below, describe any litigation in which the decedent was a plaintiff, or litigation that is pending or contemplated on behalf
of the decedent. Include the actual or estimated values of such litigation (see Form ET‑706-I, page 3, Litigation information).
Reminders:
• This report must be filed within 90 days after the final federal determination.
• Attach a completed copy of the federal audit changes, including line adjustments and supporting schedules.
• Sign the front page of this report.
• If there is an amount due on line 10, make check payable to the Commissioner of Taxation and Finance.
• Mail your report and payment (if any) to: NYS TAX DEPARTMENT, TDAB — ESTATE TAX, W A HARRIMAN CAMPUS, ALBANY NY 12227
• Use the address shown above if you use a private delivery service.
ET-115.1 (11/12) Page 3 of 4
Before completing Schedule A or B, see Form ET-706-I, page 4, Schedule A or B.
Schedule A — Computation of federal estate tax for NYS and maximum NYS credit for state death taxes
Note: References to lines on federal Form 706 are to the August 2012 version of that form, except as noted in Form ET-706-I.
20 Amount from federal Form 706, page 3, Part 5, line 11, as adjusted ........................................................... 20.
21 If the estate elected the qualified conservation easement exclusion on the federal estate tax return,
you may enter the amount of the qualified conservation easement exclusion claimed on federal
Form 706, page 3, Part 5, line 12, provided the land is located within 25 miles of a metropolitan
area, national park, or wilderness area, or within 10 miles of an Urban National Forest. ........................ 21.
22 Total gross estate, less exclusion, for New York State, as adjusted (subtract line 21 from line 20; also enter this
amount on line 4) .......................................................................................................................................... 22.
23 Total allowable federal deductions (from federal Form 706, page 3, Part 5, line 24, as adjusted) ........................... 23.
24 Family-owned business interest deduction elected for NYS for dates of death after 2003 only (see Form ET-706-I) . 24.
25 Total allowable deductions for New York State (add lines 23 and 24) ............................................................... 25.
26 Taxable estate for New York State, as adjusted (subtract line 25 from line 22; enter here and on item a on the
front page of this form) ................................................................................................................................................... 26.
27 Adjusted taxable gifts (from federal Form 706, page 1, Part 2, line 4, as adjusted) ................................................ 27.
28 Add lines 26 and 27....................................................................................................................................... 28.
29 Tentative tax on amount on line 28 (from Table A on page 4) ............................................................................ 29.
30 Total federal gift tax payable (from Form ET-706-I, Line 30 Worksheet, line 5; attach a copy of the Line 30
Worksheet to this form) .................................................................................................................................. 30.
31 Gross federal estate tax for NYS (subtract line 30 from line 29; enter here and on item b on the front page of this form) 31.
32 Maximum New York State unified credit (see Form ET-706-I; do not enter more than $345,800) ........................ 32.
33 Adjustment to unified credit (from federal Form 706, page 1, Part 2, line 10, as adjusted), if any........................... 33.
34 Allowable New York State unified credit (subtract line 33 from line 32) . ............................................................ 34.
35 Subtract line 34 from line 31 (if zero or less, enter 0) ........................................................................................ 35.
36 Amount of maximum New York State credit for state death taxes from Table B on page 4 (if more than the
amount on line 35, enter the line 35 amount here and on line 1) .......................................................................... 36.
Schedule B — Computation of federal estate tax for NYS and maximum NYS credit for state death taxes
Note: References to lines on federal Form 706-NA are to the July 2011 version.
37 Amount from federal Form 706-NA, page 2, Schedule B, line 1, as adjusted................................................
38 If the estate elected the qualified conservation easement exclusion on the federal estate tax return,
Form 706-NA, but the land is not located within 25 miles of a metropolitan area, national park, or
wilderness area, or within 10 miles of an Urban National Forest, enter the amount from federal
Form 706, page 28, Schedule U, line 20. . ................................................................................................
39 Total gross estate, less exclusion, for New York State, as adjusted (add lines 37 and 38; enter
here and on line 4) .........................................................................................................................................
40 Total federal deductions (from federal Form 706-NA, page 2, Schedule B, line 8, as adjusted) ...............................
41 State death tax deduction (from Federal Form 706-NA, page 2, Schedule B, line 7, as adjusted), if any.................
42 Total deduction for New York State (subtract line 41 from line 40)......................................................................
43 Taxable estate for NYS, as adjusted (subtract line 42 from line 39; enter here and on item a on the front page of this form) 44 Total taxable gifts (from federal Form 706-NA, page 1, Part II, line 2, as adjusted) .................................................
45 Add lines 43 and 44.......................................................................................................................................
46 Tax on line 45 amount (from Table A on page 4) ...............................................................................................
47 Tax on line 44 amount (from Table A on page 4) ...............................................................................................
48 Gross federal estate tax for NYS (subtract line 47 from line 46; enter here and on item b on the front page of this form) .
49 Allowable New York State unified credit (see Form ET-706-I) ...........................................................................
50 Subtract line 49 from line 48 (if zero or less, enter 0) ........................................................................................
51 Amount of maximum New York State credit for state death taxes from Table B on page 4 (if more than the
amount on line 50, enter the line 50 amount here and on line 1) .........................................................................
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
Page 4 of 4 ET-115.1 (11/12)
Table A — Unified rate schedule
If the taxable amount is:
over
$
0
but not over
the tax is
$ 10,000
10,000
20,000
20,000
40,000
plus
20%
of amount over
40,000
3,800
plus
22%
of amount over
20,000
60,000
8,200
plus
24%
of amount over
40,000
60,000
80,000
13,000
plus
26%
of amount over
60,000
80,000
100,000
18,200
plus
28%
of amount over
80,000
100,000
150,000
23,800
plus
30%
of amount over
100,000
150,000
250,000
38,800
plus
32%
of amount over
150,000
250,000
500,000
70,800
plus
34%
of amount over
250,000
500,000
750,000
155,800
plus
37%
of amount over
500,000
750,000
1,000,000
248,300
plus
39%
of amount over
750,000
1,000,000
1,250,000
345,800
plus
41%
of amount over
1,000,000
$
10,000
1,250,000
1,500,000
448,300
plus
43%
of amount over
1,250,000
1,500,000
2,000,000
555,800
plus
45%
of amount over
1,500,000
2,000,000
2,500,000
780,800
plus
49%
of amount over
2,000,000
2,500,000
3,000,000
1,025,800
plus
53%
of amount over
2,500,000
3,000,000
10,000,000
1,290,800
plus
55%
of amount over
3,000,000
10,000,000
17,184,000
5,140,800
plus
60%
of amount over
10,000,000
17,184,000
---------------
9,451,200
plus
55%
of amount over
17,184,000
Table B worksheet
Table B — Computation of maximum NYS credit for state death taxes
Adjusted taxable estate
for New York State
(based on federal adjusted taxable estate for NYS computed using the Table B worksheet)
If the amount from Table B
worksheet, line 3 is:
over
$
Sch. A, line 26, or
Sch. B, line 43) . .. 1.
2. Adjustment........ 2.
60,000
3. Adjusted taxable
estate for NYS
18% of taxable amount
1,800
1. Taxable estate
for NYS (from
$
(subtract line 2
from line 1) .......... 3.
Use this amount to compute maximum
credit for state death taxes in Table B.
but not over
40,000 $
the credit is
90,000 90,000 140,000 140,000
240,000
240,000
440,000
$
0.8% of amount over
$
40,000
400
plus 1.6% of amount over 1,200
plus
2.4%
of amount over
140,000
90,000
440,000
3,600
plus
3.2%
of amount over
240,000
640,000
10,000
plus
4.0%
of amount over
440,000
640,000
840,000
18,000
plus
4.8%
of amount over
640,000
840,000
1,040,000
27,600
plus
5.6%
of amount over
840,000
1,040,000
1,540,000
38,800
plus
6.4%
of amount over
1,040,000
1,540,000
2,040,000
70,800
plus
7.2%
of amount over
1,540,000
2,040,000
2,540,000
106,800
plus
8.0%
of amount over
2,040,000
2,540,000
3,040,000
146,800
plus
8.8%
of amount over
2,540,000
3,040,000
3,540,000
190,800
plus
9.6%
of amount over
3,040,000
3,540,000
4,040,000
238,800
plus
10.4%
of amount over
3,540,000
4,040,000
5,040,000
290,800
plus
11.2%
of amount over
4,040,000
5,040,000
6,040,000
402,800
plus
12.0%
of amount over 5,040,000
6,040,000
7,040,000
522,800
plus
12.8%
of amount over
6,040,000
7,040,000
8,040,000
650,800
plus
13.6%
of amount over
7,040,000
8,040,000
9,040,000
786,800
plus
14.4%
of amount over
8,040,000
9,040,000
10,040,000
930,800
plus
15.2%
of amount over
9,040,000
10,040,000
---------------
1,082,800
plus
16.0%
of amount over
10,040,000