Form 54.29
                               State Of North Dakota
                       Offi ce Of State Tax Commissioner
                       Affi davit As To Location Of Real Estate And
                              Personal Property In North Dakota

1.  ESTATE OF___________________________________________________________________________, DECEASED.
2.  STATE OF NORTH DAKOTA  )
                              )
 County of _________________  )
3.  I, ___________________________________________________ being fi rst duly sworn, on oath depose and say:
 a.  That I am the personal representative for the estate of the decedent named above;
 b.  That the decedent was a resident of _______________________________  _______________________________  
                                                          (City)                                   (County)
  _______________________________ at the time of death; and
                       (State)
 c.  That the total gross value of estate properties with situs in North Dakota owned by the decedent at the time of death 
  were located in the following cities and rural areas:

  In _____________________________,     _____________________________                         $ ________________________
   City                                    County
  In _____________________________,     _____________________________                         $ ________________________
   City                                    County
  In _____________________________,     _____________________________                         $ ________________________
   City                                    County
  In _____________________________,     _____________________________                         $ ________________________
   City                                    County
  In Rural  ________________________________________________                    County  $ ________________________
  In Rural  ________________________________________________                    County  $ ________________________
  In Rural  ________________________________________________                    County  $ ________________________
  In Rural  ________________________________________________                    County  $ ________________________
                                                                                Total Gross Estate  $ ________________________
4.  North Dakota Estate Tax ...................  $ __________________
5. Interest ..............................................  $ __________________
6.  Total Tax Plus Interest ......................  $ __________________

I, the personal representative of this estate, do hereby swear, under the penalty of perjury, that the information provided in this 
affi davit is true and correct to the best of my knowledge.
                                                          Dated this ______ day of _______________________, 20____.
 
                                                          _________________________________________________
                                                          Signature of Personal Representative

Subscribed and sworn to before me this ______ day of ______________________, 20____.

                                                          _________________________________________________
                                                          Notary Public for Personal Representative

Approved by State Tax Commissioner this _____ day of _____________________, 20 ____, at Bismarck, North Dakota.
  
Tax File No. _____________________________                Ryan Rauschenberger
                                                          Tax Commissioner
                                                          _________________________________________________
                                                          Estate Tax Examiner
24133 (updated 1-2006)                     (Submit In Duplicate)

                                   Instructions

One hundred percent of North Dakota estate taxes are distributed to cities and counties.  The State 
Treasurer uses the information from this affi davit, together with a statutory formula, to determine the 
amount of tax distribution for each city and county involved.

The affi davit must be completed in its entirety, signed, and notarized.

An amended affi davit is necessary whenever there is a change in the gross value of an estate so that 
adjustments can be made to the tax distribution.

Line 1:  Enter the decedent's name.

Line 2:  Enter the county of residence of the personal representative.

Line 3:  Enter the name of the personal representative.

Line 3b: Enter the city, county, and state which was the decedent's residence at the time of death.  
         A decedent's residence at the time of death is the place considered by the decedent as a 
         permanent home and the place to which the decedent intended to return after an absence.

Line 3c: Enter the situs and gross value of the decedent's North Dakota property.

         The dollar value must be the total "gross" value.

         The "gross" value of real property must be listed under the city or county where the property is 
         situated.

         The "gross" value of personal property must be listed under the city in which the decedent 
         was a resident at the time of death; or, if the decedent resided in a rural area, it must be listed 
         under the county in which the decedent was a resident at the time of death.  The place of the 
         decedent's residence determines the situs of all personal property.

Line 4:  Enter the total North Dakota estate tax as computed on the estate tax return or as assessed.

Line 5:  Enter the total interest due as computed on the estate tax return or as assessed.

Line 6:  Enter the total of line 4 plus line 5.