Form Ih-12 - Indiana Inheritance Tax Return For A Non-Resident Decedent
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8Prescribed by the Indiana Department of State Revenue
form Ih-12
InDIana InheRItance tax RetuRn
SF # 51492
(R2/08-07)
foR a non-ReSIDent DeceDent
note: Please read carefully the general instructions before preparing this return.
1. Decedent’s name
2. Business or occupation
3. Date of death
4. Decedent’s residence (domicile) at time of death
5. Social Security number
6. Address of decedent at time of death
7. Did the decedent die testate?
YeS
no
If yes, attach copy of will
8. name of ancillary administrator or executor
9. Address of ancillary administrator or executor
10. Location of court
11. Gross value of entire estate, wherever situated: Amount $
Is a Federal Estate Tax Return required to be filed with the IRS? YES NO
If yes, attach a copy
name, address and phone number of attorneys representing estate
Schedule A attached hereto discloses all interests of decedent in Indiana real estate and sets forth the information called for
in the heading of said schedule.
Schedule B attached hereto discloses all tangible personal property of decedent which had an actual situs in this state, as
called for in the heading of said schedule.
Schedule C attached hereto discloses all information respecting gifts, transfers and trusts as called for in the heading of said
schedule.
Schedule D attached hereto sets forth all allowable deductions in connection with the settlement of the non-resident decedent’s
estate in Indiana.
Schedule E attached hereto discloses the requested information concerning the persons beneficially interested in the property
taxable in this state.
I have made a due and diligent search for property of every kind, nature and description left by the decedent within the
jurisdiction of this state and have been able to discover only that set forth in Schedules A, B and C. no information of any
other property of the decedent has come to my knowledge, and I verily believe that the decedent left no property except as
therein set forth herein.
(Signature)
(Capacity)
(Address)
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