Estate Tax Form 21
Revised 08/02
Estate Tax Division
1 (800) 977-7711
Application for Certificate of Release of Ohio Estate Tax Lien
Estate of: Decedents last name
Decedents first name and initial
Case number
Date of death
o we
Part 1
Has an Ohio estate tax
County in Ohio
Decedents social security number
return been filed?
Part II,
c
c
Yes
No
è
Part I Identification
Print or Type
If yes, give date it was filed
Name of preparer
Month
Day
Year
Address
_______ _______ _______
Amount of tax paid or to be paid
City, state and ZIP code
$ _______________ . ______
Telephone number of preparer
Please circle appropriate title (including ancillary executor or administrator):
Executor
Administrator(s)
Name
Telephone number
Address (number and street, city, state and ZIP code)
List the approximate value of the real estate on the appropriate schedule below, list all
other gross assets under All Other Property, then list deductions as shown.
Approximate Gross Estate Values
Name and address of the purchaser, transferee,
or mortgagee and state relation to applicant
Schedule A
decedent.
Real estate
$
Schedule E
Jointly-owned property
$
Schedule G
Transfers during decedents life
$
Schedule H
Purchase/sales price on property:
Power of appointment property
$
$__________________ . _____
All other property
$
Will the estate be claiming any of the following
Total gross estate
$
on the estate tax return (ET Form 2):
J Debts & expenses of administration
$
Yes
No
Current agricultural use valuation
c
c
(CAUV) per Section 5731.011
K Charitable deductions
$
O.R.C.
L Marital deduction
$
Yes
No
Extension of time to pay estate
c
c
tax per Section 5731.25 O.R.C.
Total deductions (schedules J, K & L)
$
To be completed by the Ohio Department of Taxation
The application for this release of Ohio estate tax lien is:
c Approved
c Not Approved
Tax Commissioner
By
Date