Fill and Sign the For Decedents Dying Prior to January 1 1999 Form

Description And Location $ $ Cash, Securities, Savings Other Personal PropertyLife Insurance $ INHERITANCE AND ESTATE TAX CERTIFICATION (FOR DECEDENTS DYING PRIOR TO JANUARY 1, 1999) G.S. 28A-21-2; 105-22, -23 Name Of Decedent Date Of Death (See Side Two) Market Value File No. In The General Court Of Justice Before The Clerk IN THE MATTER OF THE ESTATE OF STATE OF NORTH CAROLINA County NOTE: Use this form for a decedent who died before 1/1/1999. For a decedent who died on or after 1/1/1999, but prior to 1/1/2013, use AOC-E-212. An estate tax certi�cation under G.S. 28A-21-2(a1) is not required for a decedent who died on or after 1/1/2013. I, the personal representative in the above estate, certify that: 1. The gross value of the estate, including any property transferred by the decedent over which the decedent had retained any interest as described in G.S. 105-2(a)(3) , as well as any property transferred within three (3) years prior to the date of the decedent’s death, is less than $75,000 (If decedent died on or after 8/1/1985 and before 7/1/1986). $450,000 (If decedent died on or after 7/1/1993 and before 1/1/1997). $150,000 (If decedent died on or after 7/1/1986 and before 1/1/1987). $600,000 (If decedent died on or after 1/1/1997 and before 1/1/1999). $250,000 (If decedent died on or after 1/1/1987 and before 7/1/1993). (See Side Two.) 2. The bene�ciaries are all Class A bene�ciaries, as described in G.S. 105-4(a), (child, grandchild, parent, etc.), or the surviving spouse. (This form should not be used if any one of the bene�ciaries is other than spouse or Class A.) 3. The following is a listing of the amount and value of all the decedent’s property, including real property located outside North Carolina, at the time of the decedent’s death. (Real estate owned by husband and wife as tenants by the entirety should be included at one-half the fair market value. Bank or savings and loan accounts and other securities owned jointly by husband and wife with right of survivorship should be included at one-half fair market value.) (Include full value of joint ownership deposit accounts and securities except between husband and wife - there, include one-half.) PERSONAL PROPERTY Market Value Tax Value (If real estate was owned by husband and wife as tenants by the entirety, include one-half value and so indicate.) REAL PROPERTY (Total Value Of Transfers from item No. 7 on Side Two) Original - File Copy - Taxpayer(Over) $ $ TRANSFERS TOTAL VALUE OF PERSONAL PROPERTY, REAL PROPERTY, AND TRANSFERS Date Title Of Person Authorized To Administer Oaths Date Title Of FiduciaryAddress Of Fiduciary Signature Signature Date Commission Expires County Where Notarized SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL AOC-E-207, Rev. 12/17 © 2017 Administrative Of�ce of the Courts 0.00 0.00 1. This form is designed to be used only for those estates in which the bene�ciary is the spouse and/or all of the other bene�ciaries are Class A. 2. This form should be used only when the gross estate, including real property, personal property, life insurance and transfers, is less than the following: If Decedent Died To Use This Form, On Or After Before Gross Estate Must Be Less Than: 8/1/1985 7/1/1986 .......................................................................... $ 75,000 7/1/1986 1/1/1987 .......................................................................... $150,000 1/1/1987 7/1/1993 .......................................................................... $250,000 7/1/1993 1/1/1997 .......................................................................... $450,000 1/1/1997 1/1/1999 .......................................................................... $600,000 3. This form should indicate whether real property is owned jointly by husband and wife as an estate by the entirety and if so, show only one-half value. 4. Joint deposit accounts and other securities held jointly by husband and wife with right of survivorship should be shown at one-half value. All other joint deposits and other securities should be shown at full value. 5. An inheritance tax return is not required when: (1) all the bene�ciaries are either a spouse, child, grandchild, or parent and (2) the gross value of the estate, including property transferred within three years of the decedent’s death without adequate valuable consideration and transfers over which the decedent retained any interest (such as a life estate), was under the amount shown above. However, under G.S. 28A-21-2(a1), a certi�cation to the Clerk of Superior Court is required and this form should be completed. 6. Please list all bene�ciaries and relationship to decedent. NAME RELATIONSHIP (Spouse, Child, Etc.) 7. Use the space below to explain any transfers over which the decedent retained any interest (such as a life estate), as well as any transfers of property within three years of death without adequate valuable consideration. (List name of donee, date of transfer, description of property, and value as of date of death.) Value $ $ TOTAL VALUE OF TRANSFERS AOC-E-207, Side Two, Rev. 12/17 © 2017 Administrative Of�ce of the Courts 0.00