Form Et 22 - Certificate Of Estate Tax Payment And Real Property Disclosure
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4ET 22
Rev. 7/03
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Estate Tax Unit
Date Estate Tax Return and/or
1-(800) 977-7711
this Form Filed in Probate Court
tax.ohio.gov
Certifi cate of Estate Tax Payment and
Real Property Disclosure
for Dates of Death on or after November 8, 1990
(Section 5731.21 O.R.C.)
This form should not be sent to the Estate Tax Unit in Columbus.
Estate of: Decedent’s last name, fi rst name and middle initial
County of residence
Case number
Date of death
Part I – Please complete either Section A or B, whichever is applicable.
A. This section is to be completed by the estate repre-
B. This section is to be completed by the estate
representative where no Ohio estate tax return is
sentative where an Ohio estate tax return is required
to be fi led.
required to be fi led.
Date of death (please check one):
Date of death (please check one):
On or after Jan. 1, 2002 – more than $338,333
On or after Jan. 1, 2002 – under $338,333
On or after Jan. 1, 2001 through Dec. 31, 2001 –
On or after Jan. 1, 2001 through Dec. 31, 2001 –
under $200,000
more than $200,000
On or after June 30, 1983 through Dec. 31,
On or after June 30, 1983 through Dec. 31,
2000 – more than $25,000.
2000 – under $25,000.
1. No estate tax return is required to be fi led because
1. The estate tax return due for this estate was fi led in
probate court on the date stamped hereon.
the gross estate, which includes all real property, falls
below the fi ling requirements set forth in R.C. section
2. All estate taxes shown due, if any, on the return have
5731.21(A)(3).
been paid in full. (This step will take effect upon veri-
2. All real property listed in the attached inventory for the
fi cation by the county auditor on page 3, Part II of this
form.)
decedent’s estate, as well as the following real property
not listed in the inventory and attached to this certifi cate,
3. All real property listed in the inventory for the decedent’s
shall be free of any lien for estate taxes under R.C.
estate is included in the estate tax return as well as the
sections 5731.02 and 5731.19(A).
following real property not listed in the inventory and
attached to this certifi cate.
4. The real property attached to this certifi cate shall be
free of any lien for estate taxes under Ohio Revised
Code (R.C.) sections 5731.02 and 5731.19(A). This
certifi cate does not take effect until verifi cation of pay-
ment of tax is received from the county auditor’s offi ce.
This certifi cate does not refl ect the tax commissioner’s
fi nal determination of estate tax under R.C. section
5731.26.
Declaration
The information contained on this certifi cate, to the best of my knowledge, is true and complete.
Name of estate representative
Address of estate representative
Signature of estate representative
Date
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