____________
____________
Court
County,
Tennessee
AFFIDAVIT REQUESTING WAIVER OF
FILING OF TENNESSEE INHERITANCE
TAX RETURN
Case
Number
IN THE MATTER OF THE ESTATE OF ________________________________________, DECEASED
The undersigned, being duly sworn, deposes and says:
1.
I am a duly qualified personal representative of this estate.
2.
This affidavit is submitted in support of a waiver of filing the Tennessee Inheritance Tax Return
as prescribed in Section 67-8-409(g) of the Tennessee Code Annotated.
3.
The Gross Estate for Tennessee Inheritance Tax purposes is valued at $_______________.
[not to exceed $100,000].
4.
The Gross Estate for Tennessee Inheritance Tax purposes consists of the following assets:
ASSETS
VALUE
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
[Attach a separate sheet if necessary to list additional assets.]
5.
_____________
_____________
_____________
_____________
_____________
The decedent made no gifts during life to any person in an amount exceeding the maximum
single exemption allowable under Section 67-8-104 of the Tennessee Code Annotated.
Under penalties of perjury, I declare the facts stated in this affidavit are true, correct, and complete to the
best of my knowledge and belief.
This ____ day of __________________, 20___.
__________________________________________
Affiant
STATE OF TENNESSEE
COUNTY OF ___________________
Sworn to and subscribed before me this ____ day of __________________, 20___.
____________________________________
Notary Public
My commission expires:___________________
www.selegal.org