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ET 12A
Department of Rev. 5/12
Ohio I Taxation
Estate Tax Unit Reset Form
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:
(Accounts) Bank Type of Account and Number Value as of Date of Death
(Stocks) No. of Shares or (Including Interest)
Denomination of Bonds Company and Type of Stock

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 F• No F• If yes, please attach a copy including all codicils.

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ET 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 F No F
If yes, did the decedent own the business? Yes F No F

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
deposit if the only beneﬁ ciary is the surviving spouse. Ef- to transfer is requested.
fective Jan. 1, 2001, pursuant to the tax commissioner’s
authorization, a consent to transfer is not required for A. Bank accounts and funds on deposit, including IRAs and
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
ET forms 12 and 14 will become obsolete for 2. Amount on deposit as per last entry prior to death and
dates of death after Dec. 31, 2012. H.B. 508, date of last entry
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 reﬂect
tax liability. An estate tax return may be required to be ﬁled 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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                                                                                                                                       ET 14A 
              Department of                           Reset Form                                                                       Rev. 5/12 
Ohio I        Taxation 
              Estate Tax Unit 
              P.O. Box 183050 
              Columbus, OH 43218-3050 
              1-(800) 977-7711 
              tax.ohio.gov 

                                           Nonresident Tax Release 

                                                                               Date 

To  
              (Name of company whose stocks or bonds are to be transferred or institution where deposit or other property is located.) 

The tax commissioner of Ohio consents to the immediate transfer of the following property now in your possession, control 
or custody: 

    (Accounts) Bank                        Type of Account and Number 
 (Stocks) No. of Shares                                   or                             Value as of Date of Death 
 Denomination of Bonds                     Company and Type of Stock                         (Including Interest) 

belonging to or standing in the name or joint name of                                               , deceased; 

date of death                         ,               , resided in                       , state of                                                . 
              Month            Day         Year                       County 

                                                                   Tax commissioner agent
 
 By 

                                                Instructions 
 This form must accompany estate tax form 12A. The           Stocks – Copy and describe each company stock as it is
 attorney for the estate or the applicant should complete    described on the application (estate tax form 12A), except 
 this form.                                                  do not carry the value over to this form as the value will
                                                             vary from date of death to date of actual transfer. Please 
 To obtain a release, forward completed estate tax forms     direct this release to the company or institution where
 12A and 14A to the Estate Tax Unit at the address above.    the property is located and not to the individual receiv-
                                                             ing the property. 
 The following is required for completion: 

 Bank Accounts – Copy and describe each account 
 exactly as it is described on the application (estate tax
 form 12A).

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