Application For Consent To Transfer Securities Or Personal Property Of Any Description OWned By A Resident Decedent {IH-14}

Form IH-14 SF# 48839 (R6 / 5-14) Not for Public Access* (Please enclose self-addressed stamped envelope.) Application for Consent to Transfer In the matter of the Estate of _________________________________________ Date of Death ___________________________ Decedent's Social Security Number ____________________________ Resident of _________________________ County Decedent's Address _______________________________________________________________________________________ I, _________________________________ (name), ____________________________ (relationship to decedent or estate), certify: 1. Check whichever applies: a. That letters testamentary were granted to ________________________________________ under Cause Number _________________________________ on _________________________________ (date). b. That no administration of the estate is pending in any court and no administration is anticipated. 2. That at the date of death the decedent owned the following property: Form of Ownership Account Number Description of Property Date of Death Value Holding Institution ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ 3. That the property listed will be transferred to the following (please type or print): __________________________________ (Name of Transferree) __________________________________ (Relationship to Decedent) __________________________________ (Address) __________________________________ (City, State, ZIP Code) __________________________________ (Telephone/Email) ________________________________ (Name of Transferee) ________________________________ (Relationship to Decedent) ________________________________ (Address) ________________________________ (City, State, ZIP Code) ________________________________ (Telephone/Email) ________________________________ (Name of Transferee) ________________________________ (Relationship to Decedent) ________________________________ (Address) ________________________________ (City, State, ZIP Code) ________________________________ (Telephone/Email) By making this application, the undersigned agree(s) to pay any Indiana Inheritance Taxes that may be imposed and file an Indiana Inheritance Tax Return that may be required by Indiana law. Further, the undersigned states, under the penalty of perjury, that the statements herein are true and correct to the best of that person's knowledge and belief. ________________________________ (Transferee Signature) __________________________________ (Transferee Signature) ________________________________ (Transferee Signature) CONSENT: The Inheritance Tax Division of the Indiana Department of Revenue hereby consents that the property described in this application be transferred to the named transferee(s) under the following condition: That the named holding institution must not transfer 20% of the jointly owned account(s). By _______________________________________________ (County Assessor and Inheritance Tax Appraiser) ___________________________________ County, Indiana American LegalNet, Inc. www.FormsWorkFlow.com ________________________________ (Date) Instructions for Completing Applications for Consents to Transfer For Personal Representatives, Joint Owners, Or Other Beneficiares Wishing To Obtain Consent To Transfer Personal Property Of An Indiana Resident Decedent This form does not need to be completed for those individuals dying after Dec. 31, 2012. For those individuals dying before Jan. 1, 2013, this form may need to be completed. 1. Complete all information concerning the decedent's name, county of residence, Social Security number, date of death, and address at the top of the form. 2. For Line 1, please check box A and list the name of the personal representative if you have opened a probate estate. Complete the cause number and date the estate was opened. If no probate estate has been opened and no administration is anticipated, leave the cause number blank and check box B. 3. For Line 2, complete all account information. Be sure to list the value of the account on the decedent's date of death. Multiple accounts held by the same holding institution (e.g. bank, brokerage, insurance company) may be reported on the same form. Use separate forms for each holding institution. 4. For Line 3, complete all transferee information including name, relationship to decedent, address, and telephone number or email address. 5. Signatures - If the estate is the beneficiary, the personal representative should sign the Consent to Transfer. If a trust is the beneficiary, the trustee should sign the Consent to Transfer. For jointly held property and payable on death accounts, all joint owners or beneficiaries must sign ­ separate forms can be used. Original signatures are preferred, but faxed or scanned signatures are acceptable. The county assessor will complete the bottom portion of the form. ** 6. File the completed forms in triplicate at the county assessor's office in the county where the decedent was a resident. 7. If submitting the application by mail, please enclose a self-addressed stamped envelope. 8. The assessor will return two copies of the consent to you: one to send to the holding institution and one for your personal records. *Once completed, this form is confidential pursuant to Ind. Code § 6-4.1-12-12. To comply with Administrative Rule 9 and Trial Rule 5(G), this form is marked "Not for Public Access" and is required to be filed with the county assessor on light green paper if it is filed for an otherwise public estate. **Where the value of a jointly owned asset exceeds a transferee's exemption amount, the county assessor may authorize the holding institution to withhold 20% of the jointly owned asset's value to ensure that the transfer does not jeopardize the collection of Indiana Inheritance Tax. Once the county assessor has determined that all taxes have been paid on the transfer or an Indiana Inheritance Tax Return has been filed, the remaining funds may be released. You may need to provide a copy of the Inheritance Tax Closing letter and/or the countersigned receipt to the holding institution to complete the transfer; however, the holding institution may require an additional Application for Consent to Transfer to be filed to release the remaining funds. **Where the value of other assets (not jointly owned) exceeds a transfer