Form 101a - Wisconsin Inheritance Tax Return - Resident Return
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4FORM 101A
Wisconsin Inheritance Tax Return
DEPT USE ONLY
AUD #
Resident Return
DETACH AND MAIL TO:
Wisconsin Department of Revenue
1
2
3
4
5
(For Gross Estates $200,000 or Less)
PO Box 8906
Madison, WI 53708
6
7
8
9
0
Estate of
Date of Death
Date of Birth
Decedent’s Social Security Number
Address of Decedent at Date of Death (number and street)
City
State
County
Occupation While Employed
If yes, attach a copy of the will and any codicils.
Did decedent have a will?
Yes
No
Did decedent file a Wisconsin income tax
Did decedent make any gifts to any individual in excess
Yes
Yes
If yes, see instructions
for Part 1, line 7.
of $10,000 in the two years immediately prior to death?
return or homestead claim for last year?
No
No
PART 1 – SUMMARY OF ASSETS AND DEDUCTIONS
Department Use Only
1. Property Solely Owned by Decedent (net amount from Part 3)
$
10P-X
1CL-X
2. Allowable Deductions (Part 5, line 5)
20P-F
2CL-F
30P-XF
3CL-XF
3. Subtotal (line 1 less line 2)
40P-XR
4CL-XR
Jointly Owned Property—Fractional Basis
50P-XFR
5CL-XFR
4.
(net amount from Part 4, Section 1)
60P-NoXF
6CL-NoXF
Jointly Owned Property—Contribution Basis
7AU-NoCO
8AU-CO
5.
(net amount from Part 4, Section 2)
Insurance Payable to Named Beneficiaries
TO VAL
6.
(attach schedule if more than one policy)
HOLD FOR
7. Other Property (itemize on separate page and attach)
CNST #
ROITL #
FEE $
}
8.
WISCONSIN TAXABLE ESTATE (add lines 3 through 7)
1
$
PART 2 – COMPUTATION OF TAX
1. Names of Distributees
2. Social Security Number
3. Distributive Shares
4. Relationship
5. Tax
9.
10. Total Distributive Shares (must equal Part 1, line 8)
11. Total of Column 5. (Enter here and on line 1, Schedule TC of Instructions.)
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12. Inheritance Tax Payable (From line 3, Schedule TC of instructions.)
2
13. Inheritance Tax Previously Paid
14.
INHERITANCE TAX DUE (plus interest, if any) OR REFUND OF EXCESSIVE PAYMENT (line 12 less line 13)
$
„
DEPT USE ONLY
DECLARATION: I declare that I have made a diligent and careful search for property of every kind left by the decedent,
and that this return, including accompanying schedules, has been examined by me, and is to the best of my knowledge
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and belief, true, correct and complete. If prepared by anyone other than the person filing this return, the preparer’s separate
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declaration is based on all information of which he or she has any knowledge.
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PERSONAL REPRESENTATIVE, special administrator, trustee, distributee or other person interested. (Section 72.30(1), Wis. Stats.)
Name
Designation
Address
Zip Code
Date
Telephone Number
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SIGN
HERE
(
)
PERSON PREPARING THE RETURN (individual and firm) if other than the preceding signer
Name
Designation
Address
Zip Code
Date
Telephone Number
„
}
SIGN
HERE
(
)
HT-004 (R. 6-09)
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