Notice Of Intended Transfer Of Checking Account
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Notice Of Intended Transfer Of Checking Account Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Notice Of Intended Transfer Of Checking Account, IH-19, Indiana Statewide, Department Of Revenue
Prescribed by the Indiana Department of Revenue
Form IH-19
State Form 48837
(R2 / 04-07)
NOTICE OF INTENDED TRANSFER OF CHECKING ACCOUNT
Name of Decedent
Social Security Number
Address
County of Residence
Date of Death (if known)
Under Code § 6-4.1-8-4.6, notice is hereby served that the checking account of the decedent qualifying under said statute, in
the possession or control of the undersigned, has been transferred to an individual other than the surviving spouse and the following
information is given concerning such property:
Description
of
Property
Account
Number
Form
of
Ownership
Name
of
Transferee(s)
Relationship
to
Decedent
Fair Market Value
at
Date of Death
Phone Number
of
Transferee(s)
Address
of
Transferee(s)
Date of Transfer
HOLDING INSTITUTION OR TRANSFER AGENT
NOTE: (If you will enclose a self-addressed,
stamped envelope and two copies of
this Notice, one will be returned to
you stamped with the date it is received and the name of the office
receiving it.)
Name
Address
City
Signature of Authorized Official
State
Zip Code
(Phone)
This notice must be provided to the county assessor of the county in which the resident decedent was domiciled
at the time of death, or to the Indiana Department of Revenue.
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