SCHEDULE
Use BLACK INK
CC
Request for a Closing Certificate for Fiduciaries
u
WisconsinDepartmentofRevenue
Firstname
u M.I.
Do not attach to Form 2
(see instructions)
Decedent'ssocialsecuritynumber
ESTATESONLYLegallastname
TRUSTSONLYLegalname
Estate's/ Trust'sfederalEIN
Individualorfirmtowhomtheclosingcertificateshouldbemailed
Attentionorc/o
Countyofjurisdiction
Address
Probatecasenumber
City
State
Zipcode
Dateofdecedent'sdeath(MM DD YYYY)
PART I
Information Required When Requesting a Closing Certificate for Estates
Yes Informal 20 $ No Other , 20 $ , 20 Yes $ No . (IfYes,encloseacopy)
Complete lines 1 through 8 and sign on page 2. For deaths prior to 1/1/08, also complete lines 9 and 10. 1. Doesthedecedenthaveawill? 2. Typeofprobate 20 $ Formal ,
3. Ifthedecedentdidnotfiletaxreturnsforthe4yearspriortodeath,entertheyearandthedecedent'sapproximateincome: 4. WasthedecedentcontactedbytheIRSand/orWis.Dept.ofRevenueinthelast3years? IfYes,explain: 5. Isthegrossincomeoftheestatelessthan$600? 6. WillafinalForm2befiledatalaterdate? 7. Isacertificaterequiredbythecourt? Yes Yes Yes No No No
Seeinstructions.
8. Enterthetotalsofeachoftheassetslistedbelow.(NOTE Whereany lineisleftblank,itwillbedeemedthatNONEistheDECLARATIONfor thatlinebytheperson(s)signingScheduleCC.) Probate AssetsEncloseacopyoftheinventory. a. RealEstate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a b. StocksandBonds. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b c. Mortgages,Notes,andCash . . . . . . . . . . . . . . . . . . . 8c d. InsurancePayabletoEstate. . . . . . . . . . . . . . . . . . . . 8d e. OtherMiscellaneousProperty. . . . . . . . . . . . . . . . . . . 8e Nonprobate Assets f. JointlyOwnedSurvivorshipDecedent'sShareof JointlyOwnedProperty. . . . . . . . . . . . . . . . . . . . . . . . 8f g. Decedent'sShareofSurvivorshipMaritalProperty. . . 8g h. InsurancePayabletoNamedBeneficiaries . . . . . . . . 8h . i. TransfersDuringDecedent'sLife(gifts,etc.) . . . . . . . 8i j. AnnuitiesandEmployeeDeathBenefits. . . . . . . . . . . 8j k. OtherAssets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8k 9. Wasafederalestatetaxreturn(Form706)filed? 1 0. Ifthegrossestateplusadjustedtaxablegiftswasmorethan $675,000,wasaWisconsinestatetaxreturn(FormW706)filed?
I-030i(R.12-08)
*I1CC08991*
NO COMMAS; NO CENTS
.00 .00 .00 .00 .00
.00 .00 .00 .00 .00 .00 .00
Yes Yes No No IfYes,datefiled IfYes,datefiled
L. Wisconsin GROSS Estate(add lines 8a through 8k). . . . . . . . . . . . . . . . . . . . . . . . . 8L
ScheduleCC
Page2
PART II
Information Required When Requesting a Closing Certificate for Trusts
Complete lines 1 through 9 and sign below. 1. Enclose a copy of the trust instrument with amendments (will /codicils) and copies of annual court accountings for past threeyears. 2. a. Name(s)ofgrantor(s) Socialsecuritynumber(s) Socialsecuritynumber(s) Yes No IfYes,explain: b. Name(s)ofgrantee(s) 3. Onwhatdatewasthetrustfunded? 4. WasthetrustcontactedbytheIRSand/orWis.Dept.ofRevenueinthelast3years?
5. a. Statereasonforclosingthetrust b. Ifdeathofbeneficiary,providenameofbeneficiary,socialsecuritynumber,lastaddress,anddateofdeath.
6. Haveyoupetitionedthecourttoclosethetrust? IfYes,encloseacopyofthepetition. IfNo,explainwhynopetitionhasbeenfiled 7. Hasthetrustmadeanannualaccountingtoacourt?
Yes
No
Yes
No
IfNo,explain
8. Isacertificaterequiredbythecourt?
Yes
No
Seepage15oftheForm2instructions
9. Enterthetotalfairmarketvalueofeachoftheassetslistedbelowthatareheldbythetrustattheendoftheyearprecedingthe finalyearofthetrust.(NOTE Whereanylineisleftblank,itwillbedeemedthatNONEistheDECLARATIONforthatlineby theperson(s)signingScheduleCC.) a. RealEstate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a . b. StocksandBonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b c. Mortgages,Notes,andCash. . . . . . . . . . . . . . . . . . . . . . 9c d. AnnuitiesandLifeInsurance . . . . . . . . . . . . . . . . . . . . . . 9d e. InterestinPartnerships,LLCs,andSCorporations. . . . . 9e f. OtherMiscellaneousProperty . . . . . . . . . . . . . . . . . . . . . 9f
.00 .00 .00 .00 .00 .00 .00
g. Total Assets(add lines 9a through 9f). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9g
I, as fiduciary, declare under penalties of law that I have examined this schedule (including accompanying documents and statements) and to the best of my knowledge and belief it is true, correct, and complete.
Yoursignature Date Daytimephone
(
PERSONPREPARINGFORM(Individualorfirm)ifotherthantheprecedingsigner Name Signatureofpreparer Date
) )
Daytimephone
(
Mailto: WisconsinDepartmentofRevenue POBox8918 MadisonWI53708-8918