FEDERAL ESTATE TAX AFFIDAVIT
State of New York Title No._______________
County of ________
I, ______________________________, being duly sworn, depose and state the following to be true under the penalty of perjury:
1. I reside at __________________________________________________.
2. I am the Executor/Administrator of the Estate of _____________________ who died a resident of ___________________ County, on the ______ day of ___________________, in the year ________.
3. If neither the Executor nor Administrator, state relationship to decedent: ___________________.
4. I am fully familiar with the assets of which the decedent died seized, which comprise the gross estate as hereinafter defined, and said gross estate is less than $________________________ and therefore said estate is not subject to any Federal Estate Tax.
5. I make this statement knowing full well that ________________________, as policy issuing agents for Stewart Title Insurance Company relies on the accuracy thereof for the purposes of issuing title insurance in the captioned matter.
Sworn to before me this______
day of _____________, 20____.
No guidelines are available for this form at this time.