NOTICE OF PAYMENT OF DEATH BENEFIT UNDER EMPLOYEES' PENSION OR PROFIT-SHARING PLAN ____
To: Estate and Gift Tax Section Audit Division State Campus Albany, N.Y. 12227
Notice is hereby given that the undersigned is about to make payment, pursuant to the terms of an employees' pension or profit-sharing plan, by reason of the death of the decedent named hereunder, to the persons named in the following schedule, and that the total amount to be paid to each of them (including the value of all future payments) is as set forth in said schedule.
Name of decedent.... Date of death.... Residence address .............
Name | Residence address | Relationship to decedent | Total amount payable |
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(Name of corporation or person......
making payment) .......
Dated:
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(Address) .......
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By:
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(Name and title of corporate officer)
Note: The above notice, in duplicate, must be mailed to Estate and Gift Tax Section, Audit Division, State Campus, Albany, N.Y. 12227, before payment is made. If any annuity or similar benefit is to be paid, there must be attached to this form a statement showing the age of the beneficiary, and all other facts necessary to compute the value of his interest.
N.Y. Comp. Codes R. & Regs. Tit. 20 § 360.5