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Form 22 - Certificate Of Estate Tax Payment And Real Property Disclosure For Dates Of Death On Or After November 8, 1990 (Section 5731.21 O.r.c.)

Ohio Department of Taxation

Date Estate Tax Return

Filed in Probate Court

Estate Tax Division

1880 E. Dublin-Granville Rd., Suite 200

Columbus, OH 43229-3529

1(800)977-7711

Certificate of Estate Tax Payment and Real Property Disclosure

for Dates of Death on or after November 8, 1990

(Section 5731.21 O.R.C.)

Part I

Description

A. This section is to be completed by the

Estate Representative.

Include permanent parcel number, address and

full legal description. (If additional space is

Estate of _____________________________

needed, use back of this page.)

Case No. _____________________________

Date of Death __________________________

County ______________________________

1. The estate tax return due for this estate was

filed in the 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 verification by the County

Auditor on Part II of this form.)

3. All real property listed in the inventory for

the decedent’ s estate is included in the es-

tate tax return as well as the following real

property not listed in the inventory and de-

scribed as follows:

Declaration

I declare that I have completed Part I-A and Part II-A of this certificate and to the best of my knowledge and belief the

information is true and complete.

______________________________________________

_______________________________________________

Name of Estate Representative

Address of Estate Representative

______________________________________________

_______________________________________________

Signature of Estate Representative

Date

The real property referred to in this certificate

payment of tax is received from the County

shall be free of, and may be regarded by all

Auditor’ s office. This certificate does not

persons as being free of, any lien for estate

reflect the Tax Commissioner’ s Final Deter-

taxes under Section 5731.02 and division (A)

mination of estate tax under Section 5731.26

of Section 5731.19 of the O.R.C. This certifi-

O.R.C.

cate does not take effect until verification of

Estate Tax Form 22

Revised 2/99

Form 22 - Certificate Of Estate Tax Payment And Real Property Disclosure For Dates Of Death On Or After November 8, 1990 (Section 5731.21 O.r.c.)

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