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 Page 2
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2Estate Tax Form 13
Page 2
Part III -- Benefits Payable by an Insurance Company (to be completed by insurer)
A consent is not necessary for straight life insurance payable to a named beneficiary other than the estate.
Name of insured
Owner of policy or contract
Name of insurance company
Type of policy or contract
Number of policy or contract
Address of insurance company
Value at date of death
If annuity, yearly payment
Beneficiary(s) name
Address
Relationship of beneficiary to decedent
Beneficiary(s) date of birth
Part IV -- Employment Related Benefits (to be completed by employer)
This form is not for IRAs and Keogh Plans held in a banking institution. See ET Form 12.
Name of employer
Address of employer
c
c
c
D.O.D. Value $_________________
Check one:
IRA
Keogh
Other
Lump sum $ ____________
Annually $ ____________
Monthly $ ____________
Other $ ____________
Beneficiary(s) name
Address
Relationship of beneficiary to decedent
Beneficiary(s) date of birth
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