Form Et 21 - Application For Certifi Cate Of Release Of Ohio Estate Tax Lien
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2ET 21
Rev. 4/12
Reset Form
Date Received by
Estate Tax Unit
P.O. Box 183050
Ohio Department of Taxation
Columbus, OH 43218-3050
1-(800) 977-7711
tax.ohio.gov
Application for Certifi cate of Release of Ohio Estate Tax Lien
For dates of death July 1, 1983 – Dec. 31, 2012
Estate of: Decedent’s last name
Decedent’s fi rst name and initial
Date of death
County in Ohio
Case number
Decedent’s Social Security #
Has an Ohio estate tax
return been fi led?
Yes
No
If “yes,” give date it was fi led
Name of preparer
Month/Day/Year
Address
Amount of tax paid or to be paid
City, state and ZIP code
$
Telephone number of preparer
Attorney
Executor Administrator(s)
Please check the appropriate title (including ancillary executor or administrator):
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 decedent.
Schedule A
$
Real estate
Schedule E
$
Jointly owned property
Schedule G
$
Transfers during decedent’s life
Schedule H
$
Purchase/sales price on property:
Power of appointment property
$
All other property
$
Total gross estate
$
Will the estate be claiming any of the following on the
estate tax return (estate tax form 2):
J
Debts and expenses of administration
$
Yes
No
$
K Charitable deductions
Current agricultural use valuation
$
(CAUV) per Ohio Revised Code
L
Marital deduction
R.C.) section 5731.011
T
Qualifi ed family-owned business
Yes
No
$
interest deduction
Extension of time to pay estate tax
per R.C. section 5731.25
$
Total deductions (schedules J, K, L and T)
To be completed by the Ohio Department of Taxation
Approved
Not approved
The application for this release of Ohio estate tax lien is:
Tax commissioner
By
Date
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