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1 Decedent’s first name and middle initial 2 Decedent’s last name 3 Decedent’s Social Security Number 4 Resident county at date of death 5 Date of death 6 Name of court 7 Court case number 8 Name of person filing return 9 Address 10 If decedent died intestate, check here 11 If decedent had a safe deposit box, check here If decedent died testate attach a copy of the will and state location 12 A Federal Estate Tax Return 706 is is not required. If 706 is filed, copy must be furnished. SUMMARY Schedule Value at Date of Death A Real B Cash, Deposits, Mortgages, Notes, Stocks and Bonds, Life Insurance Payable to Estate C Other Miscellaneous Property Transferred by Will or Intestate Law D Annuities, Pensions, Retirement Plans and Other Death Benefits E Transfers Other Than by Will or Intestate Law Gross F Deductions Taxable Estate Inheritance Tax Due Under penalties of perjury, I declare that I have examined this return, including accompanying schedules, statements, and instruments, and to the best of my knowledge and belief, it is true, correct and complete. Signature of person filing return Date Name of lawyer Address Telephone Number Indiana Inheritance Tax Return ³ ³ U U U U Not for Public Access* IH-6 SF # 48835 2-05 * Once completed, this form is confidential pursuant to IC 6-4.1-12-12. To comply with Administrative Rule 9 and Trial Rule 5(G) this form is marked “Not for Public Access” and is required to be filed on light green paper if it is filed for an otherwise public estate. ---PAGE BREAK--- INHERITANCE TAX COMPUTATION Name of Decedent Name and Address of Beneficiary Relationship and Date of Birth Value of Interest Exemption Amount of Tax 1. Total Tax 2 Not for Public Access* ---PAGE BREAK--- SCHEDULE A - REAL ESTATE (Jointly Owned Real Estate Should Be Reported on Schedule E) NAME OF DECEDENT Form IH-6 Description Acres Fair Market Value 1. Total Schedule A 3 Not for Public Access* ---PAGE BREAK--- Form IH-6 NAME OF DECEDENT SCHEDULE B CASH, DEPOSITS, MORTGAGES, NOTES, STOCKS AND BONDS, LIFE INSURANCE PAYABLE TO ESTATE (Jointly owned property should be reported on Schedule E) Description Fair Market Value 1. Total Schedule B 4 Not for Public Access* ---PAGE BREAK--- Form IH-6 NAME OF DECEDENT SCHEDULE C OTHER MISCELLANEOUS PROPERTY TRANSFERRED BY WILL OR INTESTATE LAW (Jointly owned property should be reported on Schedule E) Description Fair Market Value 1. Total Schedule C 5 Not for Public Access* ---PAGE BREAK--- Form IH-6 NAME OF DECEDENT SCHEDULE D ANNUITIES, PENSIONS, RETIREMENT PLANS AND OTHER DEATH BENEFITS (Jointly owned property should be reported on Schedule E) Description Fair Market Value 1. Total Schedule D 6 Not for Public Access* ---PAGE BREAK--- Description Fair Market Value 1. Form IH-6 NAME OF DECEDENT SCHEDULE E TRANSFERS OTHER THAN BY WILL OR INTESTATE LAW (TRUSTS, POWERS OF APPOINTMENT, TRANSFERS IN CONTEMPLATION OF DEATH OR TO TAKE EFFECT AT OR AFTER DEATH, AND JOINT TENANCIES WITH RIGHTS OF SURVIVORSHIP) Total Schedule E 7 Not for Public Access* ---PAGE BREAK--- Form IH-6 NAME OF DECEDENT SCHEDULE F - DEDUCTIONS Nature of Description of Claim, Debt or Expense Amount of Deduction 1. Total Schedule F 8 Not for Public Access*