Estate Tax Form 12-A - Application For Consent To Transfer Property

Estate Tax Form 12-A - Application For Consent To Transfer Property - 2000

Estate Tax Form 12-A

Revised 12/00

Estate Tax Division

1880 East Dublin-Granville Rd., Ste. 200

Columbus, OH 43229-3529

1 (800) 977-7711

Application for Consent to Transfer Property or Other Interest of a Non-Resident Decedent

(5731.40 O.R.C.)

Name of Decedent ________________________________________________ Date of Death_____________________

Residence (at time of death) __________________________________________________________________________

Social Security Number _______________________

Ohio County and Case Number __________________________

Decedent’s State of Domicile _________________________________________________________________________

The description and approximate value of the property to be transferred:

Value as of Date of death

Type of Account and Number

(Accounts) Bank

(Including Interest)

(Stocks) No. of Shares

One-half Value

Full Value

Denomination of Bonds

Company and Type of Stock

This application will not be processed unless this section is completed in its entirety.

Please have the Beneficiary or Legal Representative complete this section before it is submitted.

Please complete the following. Attach documentation when necessary.

1. Typed tax releases, Form 14A, for each institution.

2. Letters of appointment were issued to _______________________________________________________________

3. For any joint and survivorship property, state the name and relationship of survivor to decedent. ________________

______________________________________________________________________________________________

Yes c

No c

4. Did the decedent leave a will?

If yes, please attach a copy including all codicils.

Estate Tax Form 12-A - Application For Consent To Transfer Property - 2000