Form L-4

Form L-4
(2-03)
(Resident-Decedent)
(Form of preliminary report to secure consents to transfer where final return cannot be presently completed)
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF TAXATION
Individual Tax Audit Branch
Transfer Inheritance and Estate Tax
PO Box 249
Trenton, New Jersey 08695-0249
(609) 292-5033
Failure to fully complete this form may result in delay in issuing consents to transfer
IN THE MATTER OF THE ESTATE OF
________________________________________________________________________
____________ / ________ / ____________
Decedent’s Social Security Number
(State Full Name of Decedent)
Late of _________________________________________________________________
(City)
(County)
COUNTY OF_____________________________________________________
STATE OF _______________________________________________________
}
Affidavit of:
… Executor
… Administrator
… Heir-at-Law and Next of Kin
(Indicate above with an X)
S.S.
___________________________________________________________________ (Executor), (Administrator), (Heir-at-Law and Next of Kin) of above
named decedent say that the following declarations are true and that this affidavit is submitted for the purpose of securing consents to transfer certain assets
indicated below in advance of the filing of the regular detailed inheritance tax return.
Decedent died
}
Testate
Intestate
}
_____________________________________________________________, ____________
(Month)
Letters of
}
Administration
Testamentary
}
(Day)
(Year)
were issued by the Surrogate of the County of _____________________________________
State of _____________________________
}
__________________________________________________________________________
(Name)
Address to which all correspondence should be mailed.
__________________________________________________________________________
(Street)
(City)
(State)
(Zip)
1. Following is the status of decedent’s estate as presently established:
GROSS ESTATE - INHERITANCE TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________________
(Include all New Jersey realty, New Jersey tangible personalty, and intangible personalty
both in and outside of New Jersey.)
DEDUCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________________
(Debts, funeral, legal services, etc.)
NET ESTATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________________
FOR DECEDENTS DYING AFTER DECEMBER 31, 2001, GROSS
ESTATE ($ _________________) LESS DEDUCTIONS ($ _________________)
PLUS ADJUSTED TAXABLE GIFTS ($ __________________) FOR FEDERAL
ESTATE TAX PURPOSES UNDER THE PROVISIONS OF THE INTERNAL
REVENUE CODE IN EFFECT ON DECEMBER 31, 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________________
It is not possible at this time to complete an Inheritance † and/or Estate Tax † return for the following reasons: (Recite the facts with reference to the
unavoidable cause of delay. If more space is required, attach rider): __________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
IF DECEDENT DIED TESTATE A COPY OF THE WILL MUST BE ATTACHED.
2. The decedent in his lifetime made the following transfers of a material amount of his estate without receiving as consideration the
full financial value of the property transferred:
(List facts as to any such transfers, including dates, amounts, names and relationship of transferees to decedent. If made by deed
of trust, include copy thereof.) (Give ages of life tenants or annuitants.) (If decedent made no such transfers, state “NONE”.)
3. Decedent owned the following New Jersey real estate:
FULL
ASSESSED VALUE
DESCRIPTION
$
FULL
MARKET VALUE
$
(Indicate amount of any encumbrances on above parcels.)
4. All stocks and bonds of NEW JERSEY corporations or of banking institutions located in this State, which are registered in the
decedent’s name, are listed below. If held jointly, set forth exactly in whose names.
NAME OF COMPANY, NUMBER AND KIND OF SHARES
MARKET VALUE
$
(If any New Jersey securities are pledged as collateral, indicate the facts.)
Form L-4
Page 2
5. The following funds were on deposit in State and National Banks in New Jersey to credit of decedent as an individual, co-depositor
or otherwise:
NAME OF BANK
DATE OF
DEATH
BALANCE
CURRENT
BALANCE
TO CREDIT OF:
NOTE: Banks have permission to release fifty percent of all funds on deposit, upon application.
6. Relationship to decedent of those who survived decedent and are entitled to share in the estate.
NAMES AND ADDRESSES
RELATIONSHIP
AGES OF LIFE TENANTS
7. Consents to transfer are desired at this time covering the following items:
(If release of assets in a custodial account is desired, state the name and location of the bank or trust company and attach a list (in duplicate) of the
assets held as agent for the decedent.)
Form L-4
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8. Deponent is willing to make such payment on account as may be determined to be necessary by the Inheritance Tax Branch in order
to safeguard issuance of consents to transfer in absence of a detailed return.
9. Deponent certifies that the usual detailed resident return in connection with this estate will be filed with the Division of Taxation at
the earliest possible date.
__________________________________________________________
(Executor), (Administrator), (Heir-at-Law and Next of Kin)
`
My Home Address is __________________________________________________________
Street and Street Number
__________________________________________________________
City or Town and State
SWORN AND SUBSCRIBED TO
BEFORE ME THIS _______________________________________________
DAY OF ___________________________________________, ____________
________________________________________________________________
________________________________________________________________
Form L-4
Page 4