Form 4422 Application for Certificate Discharging Property Subject

Form

Department of the Treasury–Internal Revenue Service

4422

OMB Number
1545-0328

Application for Certificate Discharging Property
Subject to Estate Tax Lien

(September 2016)

Name of decedent (Last name, First name, Middle initial)

Year legal residence was established

Decedent's legal residence at time of death

Date of death
Decedent's social
security number (SSN)

To: Internal Revenue Service,
As provided by Internal Revenue Code section 6325(c), I apply for a certificate discharging property subject to an estate tax lien. This
property belongs to, or forms part of, the gross estate of the decedent named above.
Form 706 has been filed
Yes

Amount of tax paid

If “Yes,” give date it was filed

No

$

Give the gross estate values and deductions as reported on Form 706. If Form 706 has not been filed, show approximate amounts.

Gross Estate Values
Real estate

Gross Estate Values (continued)

$

All other property

Stocks and bonds

Total Gross Estate

Mortgages, notes, and cash

$

Deductions

Insurance on decedent's life

Funeral and administrative
expenses

Jointly owned property

Debts of decedent

Transfers during decedent's life

Marital deduction

Powers of appointment

Other deductions

Annuities

Charitable gifts and bequests

$

Total Deductions

$

If property is to be sold, transferred, or mortgaged, please complete the following.
a. Election made to value certain farm and
b. Request granted to defer
business real property as provided by IRC
payment of estate taxes
section 2032A
Yes (Complete line c.)
Yes

No

c. Payment deferred as provided by (“x” applicable box)
6166

6161

Other (specify)

No

Name and address of the purchaser, transferee, or mortgagee

Relationship to applicant and decedent
Consideration paid or to be paid
$

Under penalties of perjury, I declare that I have examined this application, including accompanying schedules
and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Date signed
Applicant
►
Sign here
Name and address of applicant

Relationship of applicant to estate

Name and address of attorney for applicant

Phone number of applicant

Phone number of attorney for applicant

(

(

(Executor, Administrator, or other title)

Catalog Number 41642G

)
www.irs.gov

)
Form 4422 (Rev. 9-2016)

Instructions for Completing Form 4422,
Application for Certificate Discharging Property Subject to Estate Tax Lien
1. Submit your application at least 45 days before the transaction date that the certificate of
discharge is needed. Doing so will allow sufficient time for review, determination, notification and
the furnishing of any applicable documents by the transaction date. If you have any questions,
contact the Advisory Estate Tax Lien Group at 408-283-1810, this is not a toll free number.
2. Attach a statement giving your reasons for applying for this certificate.
NOTE: If we have issued any other discharges on this estate, please include the dates and the
amounts.
3. Attach a description of the property for which you want a certificate of discharge. Show the value of
the property and the basis of the valuation. If the property consists of real estate, attach a separate
legal description and a preliminary title report for each parcel.
4. Attach any of the following documents that apply:
• Short form of letters testamentary,
• Copy of will,
• Copy of sale contract and closing statement (or proposed closing statement),
• Copy of the Form 706, and
• A copy of the inventory and appraisement reflecting all assets of the estate.
5. Submit a Form 8821, Tax Information Authorization. Completing this form gives the Internal
Revenue Service the authority to contact individuals or companies, if necessary, when determining
if the discharge is appropriate.
6. Provide the name, address, and telephone number of the closing attorney or representative of the
settlement company.
7. The Internal Revenue Service may request that you furnish additional information and will have
your application investigated to determine whether to issue the certificate. You will be informed of
the outcome.
8. Submit the completed Form 4422 and all supporting documents to:
Internal Revenue Service
Advisory Estate Tax Lien Group
55 South Market St.
Mail Stop 5350
San Jose, CA 95113-2324
Attn: Group Manager
9. Requests for discharge of property described on lien Forms 668-H or 668-J will also be processed
by the Advisory Estate Tax Lien Group, requests may be sent to the above address.
Paperwork Reduction Act
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103.
The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: Preparing and sending
the form to the IRS should involve 30 minutes. The estimated burden for individual taxpayers filing this form is approved under OMB control number
1545-0328 . If you have comments concerning the accuracy of the time estimate or suggestions for making this form simpler, we would be happy to hear
from you. You can send your comments to Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Form 4422 to this address.
Catalog Number 41642G

www.irs.gov

Form 4422 (Rev. 9-2016)