Ohio Application for Consent to Transfer Property or Other Interest of a Nonresident Decedent

Application for Consent to Transfer Property or Other Interest of a Nonresident Decedent
ET_ET12A_GEN_120312.indd
Ohio I

ET 12A
Rev. 5/12

Department of
Taxation

Reset Form

Estate Tax Unit
P.O. Box 183050
Columbus, OH 43218-3050
1-(800) 977-7711
tax.ohio.gov

Application for Consent to Transfer Property or Other Interest
of a Nonresident Decedent (Ohio Revised Code 5731.40)
For dates of death July 1, 1983 – Dec. 31, 2012
Name of decedent

Date of death

Address (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:
(Accounts) Bank
(Stocks) No. of Shares
Denomination of Bonds

Type of Account and Number
or
Company and Type of Stock

Value as of Date of Death
(Including Interest)

1.

2.

3.

Please complete this section in its entirety so that this application may be processed. If needed,
please have the beneficiary or legal representative complete this section before it is submitted.
Please complete the following. Attach documentation when necessary.
1. Completed tax releases, estate tax 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

4. Did the decedent leave a will? Yes F•

No F•

If yes, please attach a copy including all codicils.

ET 12A
Rev. 5/12
Page 2

5. Was the decedent engaged in a business in Ohio during the last five years prior to death? Yes F No F
If yes, did the decedent own the business? Yes F No F
Describe the decedent’s participation in the business
6. Where was the decedent registered to vote during the last five years prior to death?

7. Other information available to support place of domicile (i.e., place of car registration and driver’s license)

I hereby certify that all statements made are correct to the best of my knowledge and belief.
(Please provide name, address and telephone number of person filing this application.)

Signature and title of applicant
(executor, administrator, survivor or attorney for same)

Address

City, state and ZIP code

Telephone number

Date submitted

Instructions for Completing Estate Tax Form 12A
Note: A consent to transfer is not required for funds on
deposit if the only beneficiary is the surviving spouse. Effective Jan. 1, 2001, pursuant to the tax commissioner’s
authorization, a consent to transfer is not required for
funds on deposit if the amount is $25,000 or less per
account.
ET forms 12 and 14 will become obsolete for
dates of death after Dec. 31, 2012. H.B. 508,
129th General Assembly, revised R.C. section
5731.39. A tax release or consent to transfer
is not required for individuals with a date of
death after Dec. 31, 2012.
If a release is required, please complete this form and
mail to the address listed on the front.
Questions regarding domicile should be directed to the
same address and toll-free number.

Give an exact description of the property for which a consent
to transfer is requested.
A. Bank accounts and funds on deposit, including IRAs and
Keogh plans, in a savings and loan association or other
banking institution – provide the following:
1. Name of institution
2. Amount on deposit as per last entry prior to death and
date of last entry
3. Type of account
4. Identifying number and the manner in which the fund
is registered
B. Stocks/bonds – provide the following:
1. Total number of shares or denomination of bonds
2. Rate of interest and due date
3. Type and the manner in which they are registered, if
registered other than solely in name of decedent
It shall be assumed that all stocks are common unless otherwise indicated.

General Information
The fact that a consent to transfer may or may not be issued
does not in itself establish tax liability nor does it relieve
tax liability. An estate tax return may be required to be filed
pursuant to Ohio Revised Code (R.C.) sections 5731.19
and 5731.21. Tax liability on any property transferred will
be determined by the tax commissioner upon audit of the
estate tax return. Failure to timely file a return may subject
the taxpayer to a penalty pursuant to R.C. section 5731.22.

The tax release estate tax form 14A must accompany this
form to obtain a release. Since the tax release will reflect
only the last entry balance posted prior to death, this entry
may or may not reflect the entire date of death value with the
accrued interest due.

Ohio I

Department of
Taxation

ET 14A
Rev. 5/12

Reset Form

Estate Tax Unit
P.O. Box 183050
Columbus, OH 43218-3050
1-(800) 977-7711
tax.ohio.gov

Nonresident Tax Release
Date
To
(Name of company whose stocks or bonds are to be transferred or institution where deposit or other property is located.)

The tax commissioner of Ohio consents to the immediate transfer of the following property now in your possession, control
or custody:
(Accounts) Bank
(Stocks) No. of Shares
Denomination of Bonds

Type of Account and Number
or
Company and Type of Stock

Value as of Date of Death
(Including Interest)

belonging to or standing in the name or joint name of
date of death

,
Month

Day

, deceased;
, resided in

, state of

Year

County

Tax commissioner agent
By

Instructions
This form must accompany estate tax form 12A. The
attorney for the estate or the applicant should complete
this form.
To obtain a release, forward completed estate tax forms
12A and 14A to the Estate Tax Unit at the address above.
The following is required for completion:
Bank Accounts – Copy and describe each account
exactly as it is described on the application (estate tax
form 12A).

Stocks – Copy and describe each company stock as it is
described on the application (estate tax form 12A), except
do not carry the value over to this form as the value will
vary from date of death to date of actual transfer. Please
direct this release to the company or institution where
the property is located and not to the individual receiving the property.

.