NOTICE OF PAYMENTS OR CERTIFICATIONS
________
To: State Tax Commission
Audit Division-Estate Tax Section
State Campus
Albany, N.Y. 12227
Name of decedent............
Date of death............
Residence address............
Notice is hereby given that the undersigned has paid or certified checks for a total amount in excess of $30,000 drawn on the account or accounts of the decedent named:
Balance on the date of death............ ________
Total amount of checks paid or certified within
10 days after death............ ________
Balance............ ________
............
(Paying or Certifying Bank)
............
(Address)
By:............
(Officer)
N.Y. Comp. Codes R. & Regs. Tit. 20 § 360.8
The above notice, in duplicate, must be mailed within 45 days after date of decedent's death.