Download - Form 5173 Transfer Certificate

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Page 1: Form 5173 Transfer Certificate

Department of the Treasury - Internal Revenue Service

Transfer CertificateForm 5173 (Rev. July 2008)

ESTATE OF DATE OF DEATH

RESIDENCE AT TIME OF DEATH

By direction of the Commissioner of Internal Revenue, and in accordance with provisions of internal revenue laws and regulations, I hereby certify that any estate tax on the above-named estate has been discharged or provided for, and that the property described below may be transferred without liability under Federal estate tax law and regulations.

DATE International Cincinnati Campus Compliance Services

ORGANIZATION: DIRECTOR (signature)

Cat. No. 42322V Form 5173 (Rev. 7-2008)