Form Et 12a - Application For Consent To Transfer Property Or Other Interest Of A Nonresident Decedent (Ohio Revised Code 5731.40) Page 2
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3ET 12A
Rev. 5/12
Page 2
5. Was the decedent engaged in a business in Ohio during the last fi ve years prior to death? Yes
No
If yes, did the decedent own the business? Yes
No
Describe the decedent’s participation in the business
6. Where was the decedent registered to vote during the last fi ve 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 fi ling 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
Give an exact description of the property for which a consent
to transfer is requested.
deposit if the only benefi ciary is the surviving spouse. Ef-
fective Jan. 1, 2001, pursuant to the tax commissioner’s
A. Bank accounts and funds on deposit, including IRAs and
authorization, a consent to transfer is not required for
Keogh plans, in a savings and loan association or other
funds on deposit if the amount is $25,000 or less per
banking institution – provide the following:
account.
1. Name of institution
2. Amount on deposit as per last entry prior to death and
ET forms 12 and 14 will become obsolete for
date of last entry
dates of death after Dec. 31, 2012. H.B. 508,
3. Type of account
129th General Assembly, revised R.C. section
4. Identifying number and the manner in which the fund
5731.39. A tax release or consent to transfer
is registered
is not required for individuals with a date of
death after Dec. 31, 2012.
B. Stocks/bonds – provide the following:
1. Total number of shares or denomination of bonds
If a release is required, please complete this form and
2. Rate of interest and due date
mail to the address listed on the front.
3. Type and the manner in which they are registered, if
registered other than solely in name of decedent
Questions regarding domicile should be directed to the
same address and toll-free number.
It shall be assumed that all stocks are common unless oth-
erwise indicated.
General Information
The fact that a consent to transfer may or may not be issued
The tax release estate tax form 14A must accompany this
does not in itself establish tax liability nor does it relieve
form to obtain a release. Since the tax release will refl ect
tax liability. An estate tax return may be required to be fi led
only the last entry balance posted prior to death, this entry
pursuant to Ohio Revised Code (R.C.) sections 5731.19
may or may not refl ect the entire date of death value with the
and 5731.21. Tax liability on any property transferred will
accrued interest due.
be determined by the tax commissioner upon audit of the
estate tax return. Failure to timely fi le a return may subject
the taxpayer to a penalty pursuant to R.C. section 5731.22.
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