Indiana Application For Consent To Transfer Securities Or Personal Property Of Any Description Owned By A Resident Decedent

Application For Consent To Transfer Securities Or Personal Property Of Any Description Owned By A Resident Decedent
Form IH-14
Form IH-14
SF# 48839
(R6 / 5-14)

Not for Public Access*
Application for Consent to Transfer

(Please enclose self-addressed stamped envelope.)
In the matter of the Estate of__________________________________________ Date of Death____________________________
Decedent’s Social Security Number_____________________________ Resident of __________________________ County
Decedent’s Address ________________________________________________________________________________________
I, __________________________________ (name),_____________________________ (relationship to decedent or estate), certify:
1.	 Check whichever applies:

□

	

a. That letters testamentary were granted to_________________________________________ under Cause

	Number__________________________________ on__________________________________ (date).

□

	

b. That no administration of the estate is pending in any court and no administration is anticipated.

2.	 That at the date of death the decedent owned the following property:
Holding Institution		

Form of Ownership	

Account Number		

Description of Property	

Date of Death Value

___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
3.	 That the property listed will be transferred to the following (please type or print):
________________________________ 	
(Name of Transferee)			

___________________________________	
(Name of Transferree)			

_________________________________
(Name of Transferee)

________________________________ 	
(Relationship to Decedent)			

___________________________________	
(Relationship to Decedent)			

_________________________________
(Relationship to Decedent)

________________________________ 	
___________________________________	
(Address)				(Address)				

_________________________________
(Address)

________________________________ 	
(City, State, ZIP Code)			

___________________________________	
(City, State, ZIP Code)			

_________________________________
(City, State, ZIP Code)

________________________________ 	
(Telephone/Email)			

___________________________________	
(Telephone/Email)			

_________________________________
(Telephone/Email)	

By making this application, the undersigned agree(s) to pay any Indiana Inheritance Taxes that may be imposed and file an Indiana Inheritance
Tax Return that may be required by Indiana law. Further, the undersigned states, under the penalty of perjury, that the statements herein
are true and correct to the best of that person’s knowledge and belief.
________________________________ 	
(Transferee Signature)			

___________________________________	
(Transferee Signature)			

_________________________________
(Transferee Signature)

CONSENT: The Inheritance Tax Division of the Indiana Department of Revenue hereby consents that the property described in
this application be transferred to the named transferee(s) under the following condition:
	

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That the named holding institution must not transfer 20% of the jointly owned account(s).

________________________________ 	By________________________________________________
(Date)	(County Assessor and Inheritance Tax Appraiser)
	

____________________________________ County, Indiana

Instructions for Completing
Applications for Consents to Transfer
For Personal Representatives, Joint Owners, Or Other Beneficiares
Wishing To Obtain Consent To Transfer Personal Property Of An Indiana Resident Decedent
This form does not need to be completed for those individuals dying after Dec. 31, 2012. For those individuals
dying before Jan. 1, 2013, this form may need to be completed.
1.	 Complete all information concerning the decedent’s name, county of residence, Social Security number, date of death,
and address at the top of the form.
2.	 For Line 1, please check box A and list the name of the personal representative if you have opened a probate estate.
Complete the cause number and date the estate was opened. If no probate estate has been opened and no administration
is anticipated, leave the cause number blank and check box B.
3.	 For Line 2, complete all account information. Be sure to list the value of the account on the decedent’s date of death.
Multiple accounts held by the same holding institution (e.g. bank, brokerage, insurance company) may be reported on
the same form. Use separate forms for each holding institution.
4.	 For Line 3, complete all transferee information including name, relationship to decedent, address, and telephone number
or email address.
5.	 Signatures - If the estate is the beneficiary, the personal representative should sign the Consent to Transfer. If a trust is
the beneficiary, the trustee should sign the Consent to Transfer. For jointly held property and payable on death accounts,
all joint owners or beneficiaries must sign – separate forms can be used. Original signatures are preferred, but faxed or
scanned signatures are acceptable. The county assessor will complete the bottom portion of the form. **
6.	 File the completed forms in triplicate at the county assessor’s office in the county where the decedent was a
resident.
7.	 If submitting the application by mail, please enclose a self-addressed stamped envelope.
8.	 The assessor will return two copies of the consent to you: one to send to the holding institution and one for your personal
records.
*Once completed, this form is confidential pursuant to Ind. Code § 6-4.1-12-12. To comply with Administrative Rule 9 and
Trial Rule 5(G), this form is marked “Not for Public Access” and is required to be filed with the county assessor on light green
paper if it is filed for an otherwise public estate.
**Where the value of a jointly owned asset exceeds a transferee’s exemption amount, the county assessor may authorize
the holding institution to withhold 20% of the jointly owned asset’s value to ensure that the transfer does not jeopardize the
collection of Indiana Inheritance Tax. Once the county assessor has determined that all taxes have been paid on the transfer
or an Indiana Inheritance Tax Return has been filed, the remaining funds may be released. You may need to provide a copy
of the Inheritance Tax Closing letter and/or the countersigned receipt to the holding institution to complete the transfer;
however, the holding institution may require an additional Application for Consent to Transfer to be filed to release the
remaining funds.
**Where the value of other assets (not jointly owned) exceeds a transferee’s exemption amount, the county assessor may
decline to consent to the transfer and instead ask you or your attorney to file an Indiana Inheritance Tax Return (Form IH6) or for you to pay the inheritance tax on the transfer. Once the county assessor has determined that all taxes have been
paid on the transfer or an Indiana Inheritance Tax Return has been filed, the county assessor may consent to the transfer
by signing and dating the bottom of the Consent to Transfer (Form IH-14).