Form Et 12a & 14a - Application For Consent To Transfer Property Or Other Interest Of A Nonresident Decedent Page 2
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3ET 12A
Rev. 9/07
Page 2
5. Was the decedent engaged in a business in Ohio during the last five 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 five 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 filing 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
Keogh plans, in a savings and loan association or other
Note: A consent to transfer is not required for funds on
banking institution – provide the following:
deposit if the only beneficiary is the surviving spouse.
1. Name of institution
Effective January 1, 2001, pursuant to the tax com-
2. Amount on deposit as per last entry prior to death and
missioner’s authorization, a consent to transfer is not
date of last entry
required for funds on deposit if the amount is $25,000 or
3. Type of account
less per account.
4. Identifying number and the manner in which the fund is
registered
If a release is required, please complete this form and
mail to the address listed on the front.
B. Stocks/bonds – provide the following:
1. Total number of shares or denomination of bonds
Questions regarding domicile should be directed to the
2. Rate of interest and due date
same address and toll-free number.
3. Type and the manner in which they are registered, if
registered other than solely in name of decedent
Give an exact description of the property for which a consent
to transfer is requested.
It shall be assumed that all stocks are common unless other-
wise indicated.
A. Bank accounts and funds on deposit, including IRAs and
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 tax
form to obtain a release. Since the tax release will reflect only
liability. An estate tax return may be required to be filed pursu-
the last entry balance posted prior to death, this entry may or
ant to Ohio Revised Code (R.C.) sections 5731.19 and 5731.21.
may not reflect the entire date of death value with the accrued
Tax liability on any property transferred will be determined by
interest due.
the tax commissioner upon audit of the estate tax return. Fail-
ure to timely file a return may subject the taxpayer to a pen-
alty pursuant to R.C. section 5731.22.
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