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Rev. 5/12
Estate Tax Unit
1-(800) 977-7711
tax.ohio.gov
Amended Ohio Estate Tax Resident Return
File in duplicate with the Probate Court.
For estates with a date of death of July 1, 1983 – Dec. 31, 2012
This form is to be used to report an increase in tax liability,
claim a refund or disclose a change with no tax consequences.
Check one: Refund
Supplemental Tax
Nontaxable Disclosure
Pay supplemental tax through the county auditor’s Offi ce.
Estate of: Decedent’s last name
Decedent’s fi rst name and initial
Date of death
Address of decedent at time of death (number and street, city, state and ZIP code)
Decedent’s Social Security number
County in Ohio, in which Probate Court located, where will probated or estate administered
Case number
Taxable
Nontaxable
Date estate tax return fi led
Was it (check one):
If an estate tax form 10, Certifi cate of Determination of Final Ohio Estate Tax Liability,
has been received, attach a copy thereof to this return.
1
$
Net taxable estate as previously reported ..........................................................
Plus additional or increase (or less a decrease) in value of assets
2
$
(describe on reverse side) .......................................................................................
3
$
Total ............................................................................
Less additional or increase (or plus a reduction) in amount of deductions
4
$
(describe on reverse side) .......................................................................................
5
$
New net taxable estate ..............................................
6
$
Tentative tax due on new net taxable estate (use table on reverse side)................
7
$
Less estate tax credit (see reverse side) .................................................................
8
$
Tax due
.........................
(subtract line 7 from line 6; if line 7 is more than line 6, enter 0)
9
(
)
Less tax previously assessed or paid (
) .............
exclude any interest and penalty paid
If line 9 is less than line 8, subtract line 9 from line 8 and enter the amount
10
$
of supplemental tax now due .................................................................................
If line 9 is greater than line 8, subtract line 8 from line 9 and enter the amount
of refund now due ...................................................................................................
11
(
)
Distribution of Subdivisions’ Share of Tax
Date Filed with Probate Court
Date Received by
Ohio Department of Taxation
(Ohio Revised Code Section 5731.48 and 5731.50)
Percentage
City, Village or Township