Tax Estate Document

TAX ESTATE DOCUMENT

Decedent Name:     Date of Death:

Taxpayer Identification

Individual / Sole Proprietor C Corporation S Corporation Partnership Trust / Estate LLC Other

Taxpayer Identification Number (TIN)

Enter Social Security Number (if individual responsible):

Enter Employer Identification Number (EIN) for estate or entity:

Estate Administration / Representative

Tax Matters

Tax year or period covered by this document: From to

Have federal estate tax returns been filed for this estate? Yes No

Authority requested for representative to act on matters relating to estate tax (check all that apply):

File estate tax returns Sign tax returns and forms Receive confidential tax information

Certification and Perjury Statement

By signing below I certify, under penalty of perjury, the truth of the statements contained in this document and the following:

1. The taxpayer identification number(s) provided in this document are true, correct and complete to the best of my knowledge and belief.

2. I am the duly appointed Executor, Administrator or other authorized representative of the estate named herein and have the legal authority to sign this document on behalf of the estate and to represent the estate in tax matters.

3. All information supplied on this form is accurate and complete, and no material facts have been omitted. I understand that false statements may subject me to penalties under applicable law.

4. I agree to provide supporting records or documentation upon written request by the tax authority and to cooperate in the resolution of any questions arising from this submission.

5. I understand that this document may be used to establish or confirm the estate's taxpayer identification and the authority of the person signing to act for the estate in tax matters.

I acknowledge and affirm the statements above: I certify under penalty of perjury

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