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FORM 54-91 (Use for deaths occurring on or after 1-1-91)
Ofﬁ ce of IfAmended Return
North Dakota STATE OF NORTH DAKOTA
State Tax Commissioner Date Received
September 1, 2006 ESTATE TAX RETURN
Decedent's Name Date of Death Age

Social Security Number: Tax Dept. File Number
Tax Commissioner
Residence (domicile) Number and Street City or Township County State Zip Code
at time of death

LEGAL CAPACITY OF APPLICANT

Did the decedent die testate? If Yes, attach copy of will. Name and address of attorney
Yes No
Name and address of personal representative

Name and location of court and type of proceeding

COMPUTATION OF TAX

1. Federal gross estate (from line 1, page 1, Federal Form 706) ................................................................. $ ___________________
2. Portion of federal gross estate having situs in North Dakota ................................................................. $ ___________________
3. Percentage of property in North Dakota - use 6-digit decimal only - (line 2 ÷ line 1) ........................... %___________________
4. Amount of credit for state taxes on Federal Return (from page 1, Federal Form 706) ........................... $ ____________________
5. North Dakota estate tax (line 4 multiplied by line 3) .............................................................................. $ ____________________
6. Interest due, if any, to date of payment (1% per month or any fraction thereof -
N.D.C.C. § 57-37.1-07) ........................................................................................................................... $ ____________________
7. Total estate tax plus applicable interest (line 5 plus line 6) ..................................................................... $ ____________________
8. Taxes previously paid .............................................................................................................................. $ ____________________
9. Additional tax plus applicable interest (line 7 minus line 8) ................................................................... $ ____________________

PLEASE ATTACH COMPLETE COPY OF FEDERAL FORM 706 AND,
IF APPROPRIATE, ATTACH NORTH DAKOTA FORMS 54.29 AND 131-3
MAIL TO: OFFICE OF STATE TAX COMMISSIONER, 600 E. BOULEVARD AVE. DEPT. 127, BISMARCK ND 58505-0599

Under criminal penalties, I declare that this return, including accompanying documents, has been examined by me, and is, to the best
of my knowledge and belief, true, correct, and complete.

____________________________________________________________________________ ________________________________________________
(Signature of Applicant) (Date)
Do Not Write
In This Space
_____________________________________________ ______________
(Signature of Preparer) (Date)

24137 (9-2006)

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Instructions

A North Dakota Estate Tax Return must be ﬁ led when a resident decedent's total "gross" estate is equal to or in excess
of the minimum which requires the ﬁ ling of a federal estate tax return. The same requirement applies to the estate
of a nonresident decedent who owned real property in North Dakota. Real property includes mineral interests.

The following documents must accompany the North Dakota estate tax return:

1. A copy of the signed and dated Federal Form 706 estate tax return, including all schedules.

2. A copy of the appraisal upon which the real property values are based OR a Supplemental Agricultural
Property Information Form 131-3. Form 131-3 must be submitted to the County Director of Tax
Equalization or County Auditor in the county where the property is located for completion of the
"Assessed Value" portion of the form. Required only if the real property includes agricultural
acreage.

3. An Afﬁ davit as to Location of Real Estate and Personal Property in North Dakota Form 54.29.
Required only if there is an estate tax due. This afﬁ davit is very important. It is the document
used by the State Treasurer to determine distribution of the tax revenue.

Complete the top portion of the form. Note: (1) If there are no probate proceedings, do not make an entry under
"name and location of court and type of proceeding." (2) If the decedent's property was jointly owned with a surviving
spouse or other heir and no personal representative was appointed, enter the name and address of the surviving joint
tenant under "Name and Address of Personal Representative." (3) If an attorney has not been appointed to represent
the estate, do not make an entry under "Name and Address of Attorney."

The North Dakota estate tax is a pickup tax based upon the credit for state death taxes as computed on the federal
estate tax return. The information from the federal estate tax return must be used to complete the state estate tax
return.

Line 1: Enter the total "gross" estate from line 1, page 1 of the Federal Form 706. Do not enter the total
"net" or "taxable" estate from line 3, page 1, nor the total from line 5, page 1 which includes taxable
"gifts." For estates of nonresident decedents, do not enter just the percentage of property located
in North Dakota on this line.

Line 2: Enter the total "gross" value of the decedent's property which has taxable situs in North Dakota.

Line 3: Enter the percentage - using a 6-digit number - that the property which has taxable situs in North
Dakota bears to the total gross estate. (Line 2 ÷ Line 1)

Line 4: Enter the total credit for state death taxes from page 1 of the Federal Form 706.

Line 5: Enter the portion of the credit for state death taxes attributable to the property having a taxable
situs in North Dakota. (Line 4 x Line 3)

Line 6: Enter interest, if applicable. Interest accrues at the rate of 1% per month beginning with a date 15
months after the date of death on unpaid taxes.

Line 7: Enter the total tax plus applicable interest due.

Line 8: If this is an amended return, enter the previous tax paid.

Line 9: Enter the additional tax plus applicable interest due. (Line 7 - Line 8)

MAKE CHECK PAYABLE TO THE OFFICE OF STATE TAX COMMISSIONER

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