Estate Tax Form 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefits And Retirement Plans For Resident And Non-Resident Decedents - 2000
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1
2Estate Tax Form 13
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 the Proceeds of Insurance Contracts, Employer
Death Benefits and Retirement Plans for Resident and Non-Resident Decedents
(5731.39 O.R.C.)
Part I -- Identification
Decedent’s Last Name
Decedent’s First Name and Initial
Date of Death
Decedent’ Residence
County of Residence
street
city, village, township
Decedent’s Social Security Number
Case Number
Name of Surviving Spouse if applicable
Estate Representative(s) Last Name
First Name
Estate Representative(s) Address
Applicant(s) Last Name
First Name
Applicant’s Address
Signature of Applicant
Title
Part II -- To be Completed by Agent of the Tax Commissioner (County Auditor)
in the County of the Decedent’s Residence
The application for consent to transfer is:
c
c
Approved
Not Approved
Tax Commissioner
By
Date
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