Form Et 22 - Certificate Of Estate Tax Payment And Real Property Disclosure - Ohio Department Of Txation
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4ET 22
Rev. 5/12
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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 Nov. 8, 1990 – Dec. 31, 2012 (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.
B. This section is to be completed by the estate
A. This section is to be completed by the estate repre-
representative where no Ohio estate tax return is
sentative where an Ohio estate tax return is required
required to be fi led.
to be fi led.
Date of death (please check one):
Date of death (please check one):
On or after Jan. 1, 2002 – Dec. 31, 2012 – under
On or after Jan. 1, 2002 – Dec. 31, 2012 – more than
$338,333
$338,333
On or after Jan. 1, 2001 – Dec. 31, 2001 – more than
On or after Jan. 1, 2001 – Dec. 31, 2001 – under
$200,000
$200,000
On or after June 30, 1983 – Dec. 31, 2000 – under
On or after June 30, 1983 – Dec. 31, 2000 – more
$25,000.
than $25,000.
1. The estate tax return due for this estate was fi led in
1. No estate tax return is required to be fi led because
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 verifi ca-
2. All real property listed in the attached inventory for the
tion by the county auditor on page 3, Part II of this form.)
decedent’s estate, as well as the following real property
3. All real property listed in the inventory for the decedent’s
not listed in the inventory and attached to this certifi -
estate is included in the estate tax return as well as the
cate, shall be free of any lien for estate taxes under
following real property not listed in the inventory and at-
R.C. sections 5731.02 and 5731.19(A).
tached 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 payment of tax is
received from the county auditor’s offi ce. This certifi cate
does not refl ect the tax commissioner’s fi nal determina-
tion 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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