Form 40D – Fill Out and Use This PDF

Form 40D is a tax form issued by the Internal Revenue Service. It's used to report the sale of stock in excess of $100,000 or a personal residence for more than $500,000.

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Form 40D PDF Details

Form 40D is a state tax form that is used to report the estate's Indiana taxable income. The form must be filed by the executor of the estate, and it must be accompanied by a federal estate tax return (Form 706) and an Indiana inheritance tax return (Form IT-40). The information on Form 40D is used to determine the amount of Indiana estate taxes that are owed. If you are the executor of an estate that owes Indiana estate taxes, you will need to file Form 40D. The form can be downloaded from the Indiana Department of Revenue website, and it must be filed by April 15th following the year in which the decedent died.

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Question	Answer
Form Name	Form 40D
Form Length	1 pages
Fillable?	Yes
Fillable fields	21
Avg. time to fill out	4 min 31 sec
Other names	north american life insurance beneficiary change form, north american company for life and health insurance beneficiary change form, nacolah change of beneficiary, north american company for life and health beneficiary form

12

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By signing below, I agree that under the terms of my contract with North American, any commission not yet paid to me at the time of my death shall be payable to the above-named beneficiary.

*FORM MUST BE NOTARIZED*

Dated at ___________________, ____________________, the

CLEAR FORM

BENEFICIARY DESIGNATION FORM

This form allows you to designate your beneficiary to receive vested commissions otherwise due to you in the event of your death. Once your beneficiary has provided us with a certified copy of your death certificate and the Deceased Agent Beneficiary Form, any commission will be payable to the beneficiary listed on file with us under the terms of the agreement set in your agent contract with North American Company for Life and Health Insurance® (North American). All payments will be made in accordance with the applicable contract with the company (copy available upon request). The beneficiary would also be responsible for any taxes incurred by payment of said commissions. In the event that you wish to change the designation of the beneficiary, the new designation would terminate the interest of all previous beneficiaries. In the event that you should have an indebtness with North American, commissions would be applied to the debt first, and then to the beneficiary.

BENEFACTOR INFORMATION (please print or type):

LAST NAMEFIRST NAMEMI SOCIAL SECURITY # AGENT #

ACTION TO BE TAKEN:
r Add Beneficiary	r Modify Beneficiary Information						r Change Beneficiary
BENEFICIARY INFORMATION:

FULL NAME (must be natural person or trust*)				SOCIAL SECURITY/TIN #				DATE OF BIRTH

ADDRESS		CITY, STATE					ZIP CODE	PHONE

AGENT SIGNATURE

DATE

*A copy of the trust must be provided.

Return completed form to:

North American Company for Life

and Health Insurance®, Annuity Service Center Attention: Commissions Department

4350 Westown Parkway West Des Moines, IA 50266 Fax: (866)322-7072

(state)(county)

__________ day of _______________________, 20________.

Signed and sworn to (or affirmed) before me by

__________________________________________________.

NAME(S) OF PERSON(S)

_________________________________________________________________

(sIGNATURE OF NOTARY)

STAMP/SEAL:

16367Z

PRT 05-12

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