Form 4422 Application for Certificate Discharging Property Subject

Department of the Treasury–Internal Revenue Service

4422

OMB Number
1545-0328

Application for Certificate Discharging Property
Subject to Estate Tax Lien

Form
(February 2018)

Name of decedent (last name, first name, middle initial)

Decedent's Social Security Number (SSN)

Date of death

Decedent's legal residence at time of death

Estate's Employer
Identification Number (EIN)

As provided by Internal Revenue Code § 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.
If Form 706 has not been filed, provide estimate of If Form 706 has been filed, provide date
tax due

Amount of tax paid with filed or unfiled
return

$

$

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

Gifts that will be reported or have
been reported on Form 709

$

Total Gross Estate

$

Mortgages, notes, and cash
Insurance on decedent's life

Deductions

Jointly owned property

Funeral and administrative
expenses

Transfers during decedent's life

Debts of decedent

Powers of appointment

Marital deduction

Annuities

Other deductions

$

Charitable gifts and bequests
Total Deductions

$

If property is to be sold, transferred, or mortgaged, complete the following and see additional instructions below.
a. Election made to value certain farm and
business real property as provided by
IRC § 2032A

b. Request granted or will be
requested to defer payment
of estate taxes

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

6161
Yes

Yes (Complete line c.)

No

No

6166

6163

Amount paid with Form 4768 $

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,
exhibits, affidavits and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Applicant
Sign here

►

Attorney for
Applicant Sign here

►

Catalog Number 41642G

Signature

Date signed

Signature

Date signed

www.irs.gov

Form 4422 (Rev. 2-2018)

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)

)

Fax number of attorney for applicant

Physical address of the property being sold

(
Title or Escrow Company used for settlement

)

Contact name

)

Phone number of contact
(

)

Instructions for Completing Form 4422,
Application for Certificate Discharging Property Subject to Estate Tax Lien
1. If property included in the gross estate is sold, the executor must request a discharge of the specified property
from any applicable estate tax lien.
Submit your application at least 45 days before the transaction date 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) 283-2062, 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, the
physical address of property being sold and a preliminary title report for each parcel.
4. To facilitate timely processing of the application, 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 current title report and appraisal,
• Copy of the Form 706
• If return is not filed a draft of Form 706, and/or a copy of the inventory and appraisement reflecting all assets
of the estate.
• Form 4768, Application for Extension of Time to File a return and/or Pay U.S. Estate (and GenerationSkipping Transfer) Taxes
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, telephone and fax 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.

Catalog Number 41642G

www.irs.gov

Form 4422 (Rev. 2-2018)

8. If Form 706 has not yet been filed or if the Internal Revenue Service has not completed our review of Form 706,
we will determine on a case by case basis the amount of funds, if any, the estate will be required to either pre-pay
from the sale proceeds or have held in escrow.
9. 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
E-fax number: 877-477-9243
10. 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. 2-2018)