Form Ih-14 - Application For Consent To Transfer

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Form IH-14
SF# 48839
(R5 / 04-11)
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)
(City, State, Zip)
(City, State, Zip)
________________________________
__________________________________
________________________________
(Telephone/E-mail)
(Telephone/E-mail)
(Telephone/E-mail)
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:
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

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