Estate Tax Form 4 - Ohio Non-Resident Estate Tax Return - 2000

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Estate Tax Form 4
Revised 12/00
Estate Tax Division
1880 East Dublin-Granville Rd., Ste. 200
Columbus, OH 43229-3529
1 (800) 977-7711
Ohio Non-Resident Estate Tax Return (Section 5731.19 O.R.C.)
This form must accompany ET Form 2
File in duplicate with County Probate Court in Ohio
c
c
Check one:
Taxable
Non-Taxable
Estate of: Decedent’s last name
Decedent’s first name & initial
Date of death
County in Ohio where property located
State of domicile
Decedent’s social security number
c
c
Did decedent ever reside in Ohio?
No
Yes
If “yes,” state place, dates and duration of residence.
Computation
1.
Total Ohio Tax on property in all jurisdictions ..................................................................................... $ ________________________
(from page 1, line 6 of ET 2)
2.
Total Gross Value of all property having a taxable situs in Ohio ......................................................... $ ________________________
(real property & tangible personal property)
3.
Total Gross Value of property in all jurisdictions ................................................................................. $ ________________________
(from page 1, line 1 of ET 2)
x
1.
2.
$
3.
(Ohio Estate Tax Due)
Name of Executor/Administrator(s)
Address (number and street, city, state and zip code)
Telephone number
Name of Attorney representing the estate
Address (number and street, city, state and zip code)
Telephone number
Declaration
Under penalties of perjury, I declare that I have examined
deceased’s personal representative or person in possession
this return, including accompanying schedules and state-
of property is based on all information of which preparer has
ments, and to the best of my knowledge and belief, it is true,
any knowledge.
correct and complete. Declaration of preparer other than
Signature of Executor/Administrator
Date
Signature of Preparer
Date
Date Filed with
Distribution of Subdivisions’ Share of Tax
Date Received by
Probate Court
(Section 5731.48 & 5731.50 O.R.C.)
Ohio Department of Taxation
Percentage
City, Village or Township

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