Form Et 12a - Application For Consent To Transfer Property Or Other Interest Of A Nonresident Decedent (Ohio Revised Code 5731.40)

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ET 12A
Rev. 5/12
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:
Type of Account and Number
Value as of Date of Death
(Accounts) Bank
or
(Including Interest)
(Stocks) No. of Shares
Denomination of Bonds
Company and Type of Stock
1.
2.
3.
Please complete this section in its entirety so that this application may be processed. If needed,
please have the benefi ciary 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
No
If yes, please attach a copy including all codicils.

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