ET_ET22_GEN_013106.pmd

ET 22

Rev. 7/03

Certificate of Estate Tax Payment and

Real Property Disclosure

for Dates of Death on or after Nov. 8, 1990

Date Estate Tax Return and/or

This Form Filed in Probate Court

Estate of: Decedent’s last name Decedent’s first name and initial

County of residence Case number Date of death

This form should not be sent to the Estate Tax Division in Columbus.

Part I – Please complete either Section A or B, whichever is applicable.

A. This section is to be completed by the estate repre-

sentative where an Ohio estate tax return is required

to be filed.

Date of death (please check one):

F On or after Jan. 1, 2002 – more than $338,333

F On or after Jan. 1, 2001 through Dec. 31, 2000 –

more than $200,000

F On or after June 30, 1983 through Dec. 31, 2000 –

more than $25,000.

1. The estate tax return due for this estate was filed in

probate court on the date stamped hereon.

2. All estate taxes shown due, if any, on the return have

been paid in full. (This step will take effect upon verifica-

tion by the county auditor on page 3, Part II of this form.)

3. All real property listed in the inventory for the decedent’s

estate is included in the estate tax return as well as the

following real property not listed in the inventory and at-

tached to this certificate.

4. The real property attached to this certificate shall be free

of any lien for estate taxes under Ohio Revised Code

(R.C.) sections 5731.02 and 5731.19(A). This certificate

does not take effect until verification of payment of tax is

received from the county auditor’s office. This certificate

does not reflect the tax commissioner’s final determina-

tion of estate tax under R.C. section 5731.26.

B. This section is to be completed by the estate repre-

sentative where no Ohio estate tax return is re-

quired to be filed.

Date of death (please check one):

F On or after Jan. 1, 2002 – under $338,333

F On or after Jan. 1, 2001 through Dec. 31, 2000 –

under $200,000

F On or after June 30, 1983 through Dec. 31, 2000 –

under $25,000.

1. No estate tax return is required to be filed because the

gross estate, which includes all real property, falls be-

low the filing requirements set forth in R.C. section

5731.21(A)(3).

2. All real property listed in the attached inventory for the

decedent’s estate, as well as the following real property

not listed in the inventory and attached to this certifi-

cate, shall be free of any lien for estate taxes under R.C.

sections 5731.02 and 5731.19(A).

The information contained on this certificate, to the best of my knowledge, is true and complete.

Name of estate representative Address of estate representative

Signature of estate representative Date

Declaration

Estate Tax Division

1-(800) 977-7711

tax.ohio.gov

Instructions for Completion

ET 22

Rev. 7/03

Page 2

If an estate tax return is

required to be filed

no estate tax return

is required to be filed

Probate Court

If an estate tax return

is required to be filed

If no estate tax return

is required to be filed

County Auditor

If an estate tax return is

required to be filed

no estate tax return

is required to be filed

Property Description

If an estate tax return is

required to be filed

no estate tax return

is required to be filed

The estate representative completes Section A in Parts I and II of this certificate. The

estate representative is required to sign Part I of the certificate. For dates of death on or

after November 8, 1990, this certificate is required to accompany one of the following

returns when it is filed with the probate court:

(a) Resident Ohio Estate Tax Return (estate tax form 2)

(b) Nontaxable Return (estate tax form 2)

(d) Amended Resident Ohio Estate Tax Return (estate tax form 2X)

The estate representative completes Section B in Part I only. The estate representative

is required to sign Part I of this certificate.

Upon receipt of one of the above-listed returns for filing, the probate court date stamps

both the return and Part I of this certificate.

Part I is maintained in the court’s public record file. Part II of this certificate is forwarded

to the county auditor with the filed return or estate tax form 5 for verification of payment

of tax.

After receipt of Part II of this certificate from the county auditor, the probate court signs

and date stamps Section C. Part II is then filed with Part I in the public record file.

The probate court date stamps Part I of this certificate. Part I is then maintained in the

probate court’s public record file. Part II is not applicable.

If the estate taxes have been paid in full, the county auditor completes Section B of

Part II of this certificate to verify that the taxes have been paid in full. The county auditor

validates the date the return was filed. Part II of this certificate is maintained at the

county auditor’s office until all taxes shown to be due have been paid. When the

taxes are paid, the county auditor signs and date stamps Part II. After completion, Part

II is returned to the probate court. This same procedure is followed for nontaxable filings.

Neither Part I nor Part II of this certificate shall be forwarded to the county auditor’s

office.

Attach all real property not listed in the inventory including permanent parcel number,

address and full legal description.

Attach a copy of the inventory for the decedent’s estate as well as all real property not

listed on the inventory, including permanent parcel number, address and full legal de-

scription.

Estate Representative

A. This section is to be completed by the estate representative.

Estate of Case number

Date of death County

B. This section is to be completed by the county auditor.

I hereby verify that the estate taxes shown due on the estate tax return filed on

have been paid in full.

County auditor

By:

Deputy

C. This section is to be completed by the probate judge.

The verification of this certificate by the county auditor was filed in this court on the date

stamped hereon.

Probate judge

By:

Deputy

Certificate of Estate Tax Payment and Real Property Disclosure

for Dates of Death on or After Nov. 8, 1990

(R.C. Section 5731.21)

Part II

ET 22

Rev. 7/03

Page 3

Date Tax Paid to

County Auditor

Date Filed in

Probate Court

Instructions for Completion

ET 22

Rev. 7/03

Page 4

If an estate tax return is

required to be filed

no estate tax return

is required to be filed

Probate Court

If an estate tax return

is required to be filed

If no estate tax return

is required to be filed

County Auditor

If an estate tax return is

required to be filed

no estate tax return

is required to be filed

Property Description

If an estate tax return is

required to be filed

If no estate tax return

is required to be filed

The estate representative completes Section A in Parts I and II of this certificate. The

estate representative is required to sign Part I of the certificate. For dates of death on or

after Nov. 8, 1990, this certificate is required to accompany one of the following returns

when it is filed with the probate court:

(a) Resident Ohio Estate Tax Return (estate tax form 2)

(b) Nontaxable Return (estate tax form 2)

(d) Amended Resident Ohio Estate Tax Return (estate tax form 2X)

The estate representative completes Section B in Part I only. The estate representative

is required to sign Part I of this certificate.

Upon receipt of one of the above-listed returns for filing, the probate court date stamps

both the return and Part I of this certificate.

Part I is maintained in the court’s public record file. Part II of this certificate is forwarded

to the county auditor with the filed return or Estate Tax Form 5 for verification of payment