Ohio Application for Consent to Transfer the Proceeds of Insurance Contracts, Employer Death Benefits and Retirement Plans for Resident and Nonresident Dec

Application for Consent to Transfer the Proceeds of Insurance Contracts, Employer Death Benefits and Retirement Plans for Resident and Nonresident Dec
ET_ET13_FI_120312.indd
Ohio I

ET 13
Rev. 4/12

Department of
Taxation
Estate Tax Unit
1-(800) 977-7711
tax.ohio.gov

Reset Form

Application for Consent to Transfer the Proceeds of Insurance Contracts,
Employer Death Benefits and Retirement Plans for Resident and
Nonresident Decedents (Ohio Revised Code 5731.39)
For dates of death July 1, 1983 – Dec. 31, 2012

Part I – Identification
Name of decedent

Date of death

I

Decedent’s address at time of death (number and street, city, state and ZIP code)

Decedent’s Social Security number
County of residence
Case number

Is the decedent’s estate in the process of administration?
Yes F•••No F
Name and address of estate representative:

The gross value of all property held in the decedent’s name
alone or owned jointly by decedent at death or transferred
by the decedent prior to death; including, but not limited to:
real estate; cash; automobiles; household goods; insurance
payable to an estate, pension plans and annuities payable
after death including IRA and Keogh plans (check according to date of death):
Date of death (DOD) Jan. 1, 2002 – Dec. 31, 2012
F More than $338,333 F Under $338,333

Name and address of attorney representing estate:

DOD on or after Jan. 1, 2001 thru Dec. 31, 2001
F More than $200,000 F Under $200,000
DOD on or after June 30, 1983 thru Dec. 31, 2000
F More than $25,000
F Under $25,000

Note: If the gross estate is less than $338,333, $200,000
or $25,000 on the applicable date of death, no estate tax
return is required to be filed.

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.)

Date submitted

Signature and title of applicant
(executor, administrator, survivor or attorney for same – circle one)

Applicant’s name

Address

City, state, ZIP code

Telephone number

Part II – To Be Completed By Agent of the Tax Commissioner (County Auditor) in the County
of the Decedent’s Residence
The application for consent to transfer is:

Tax commissioner agent

Approved F

Not approved F

By

Date

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Rev. 4/12
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Part III – Benefits Payable by an Insurance Company (to be completed by insurer)
1. A consent is not necessary for straight life insurance payable to a named beneficiary other than the estate.
2. Please complete Part V – listing all beneficiaries’ information
3. A separate application consent form is not required for each beneficiary. Please complete only one consent application form for each policy or contract.
Name of insured

Owner of policy or contract

Name and address of insurance company

Type of policy or contract

Number of policy or contract

Value at date of death

If annuity, yearly payment

Part IV – Employment-Related Benefits (to be completed by employer)
1. A separate application consent form is not required for each beneficiary. Please complete only one consent application form for each death benefit.
2. Please complete Part V – listing all beneficiaries’ information

This form is not for IRAs and Keogh plans
held in a banking institution.
Use estate tax forms 12 and 14.

Name and address of employer

Check one:•

Date of death value $
Lump sum $

Annually $

F•IRA

F•Keogh

F•Other

Monthly $

Other

Part V – Beneficiary Information
Please complete the beneficiary information as it applies to Part III and Part IV above.
Beneficiary’s Name
1.
2.
3.
4.
5.
6.

Address

Relationship to Decedent

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Rev. 4/12
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General Information
All county auditors have been appointed agents of the tax commissioner for the purpose of issuing consents to transfer (R.C. section 5731.41)

How to obtain
a release

Submit this completed application to the county auditor in the county of the
decedent’s residence. The county auditor will review the application and return a
copy to the applicant. If the name and address of the county auditor are needed,
please call the Ohio Department of Taxation, Estate Tax Unit, at 1-800-977-7711.
1. Complete a separate application for each benefit.
2. Application will not be processed unless completed in its entirety and signed by the
applicant.
3. The approval of a consent to transfer does not determine a tax liability.
4. The county auditor will forward a copy of the approved application to the tax commissioner.
For nonresident decedents, submit this completed application to the Ohio Department of Taxation, Estate Tax Unit, P.O. Box 183050, Columbus, OH 43218-3050. This
unit will review the application and return a copy to the applicant.

A consent must be obtained for the following:

When a consent to
transfer is required
(R.C. section 5731.09(A)
and (B) and R.C. section
5731.39 (C) and (D)

1.
2.
3.
4.
5.
6.

Annuities payable to a named beneficiary or the estate.
Matured endowments payable to a named beneficiary or the estate.
Supplemental contracts payable to a named beneficiary or the estate.
Straight life insurance payable to the estate.
Life insurance owned by decedent on the life of another person.
Employer-related death benefits in excess of $2,000, including:
a. retirement benefits payable to a named beneficiary or the estate;
b. pension or profit-sharing plans payable to a named beneficiary or the estate;
c. IRAs payable to a named beneficiary or the estate;
d. Keoghs payable to a named beneficiary or the estate;
e. corporate plans, whether qualified or unqualified, payable to a named beneficiary
or the estate;
f. any deferred compensation program; and
g. bonus plans.

A consent is not required for the following:

When a consent
to transfer is not
required
(R.C. section 5731.09)

1. Date of death is after Dec. 31, 2012. H.B. 508, 129th General Assembly, revised R.C.
section 5731.39. A tax release or consent to transfer is not required for individuals
with a date of death after Dec. 31, 2012.
2. Straight life insurance benefits payable to a named beneficiary other than the estate;
or
3. When any of the above-listed assets are payable to the surviving spouse and the
date of death is on or after 10/01/96; or
4. Any of the above-listed assets are $25,000 or less, regardless of beneficiary; or
5. The Federal Coal Mine and Safety Act annuity payable under Title IV of 1969 (black
lung benefits).