ET 22
                                                                                                        Rev. 5/12
     Estate Tax Unit                               Reset Form                                     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.

 A. This section is to be completed by the estate repre-          B. This section is to be completed by the estate 
   sentative where an Ohio estate tax return is required           representative where no Ohio estate tax return is 
   to be fi led.                                                    required to be fi led.
   Date of death (please check one):                                Date of death (please check one):
   F On or after Jan. 1, 2002 – Dec. 31, 2012 – more than          F On or after Jan. 1, 2002 – Dec. 31, 2012 – under 
     $338,333                                                         $338,333
   F On or after Jan. 1, 2001 – Dec. 31, 2001 – more than          F On or after Jan. 1, 2001 – Dec. 31, 2001 – under 
     $200,000                                                         $200,000
   F On or after June 30, 1983 – Dec. 31, 2000 – more              F On or after June 30, 1983 – Dec. 31, 2000 – under 
     than $25,000.                                                    $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-
   tion by the county auditor on page 3, Part II of this form.)   2. All real property listed in the attached inventory for the 
                                                                   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

                                                                                                           ET 22
                                                                                                           Rev. 5/12
                                                                                                           Page 2

                              Instructions for Completion

Estate Representative 

If an estate tax return is f The estate representative completes     Section A in Parts I and II of this certifi cate. 
required to be fi led         The estate representative is required to sign Part I of the certifi cate. Note: For dates 
                             of death Nov. 8, 1990 – Dec. 31, 2012, this certifi cate is required to accompany one 
                             of the following returns when it is fi led with the probate court:
                              (a)  Resident Ohio Estate Tax Return (estate tax form 2)
                              (b)  Nontaxable Return (estate tax form 2)
                              (c)  Ohio Nonresident Estate Tax Return (estate tax form 4)
                              (d)  Amended Resident Ohio Estate Tax Return (estate tax form 2X)

                           f The ET Form 22 will become obsolete for dates of death after Dec. 31, 2012.

If no estate tax return    f The estate representative completes Section B in Part I only. The estate representa-
is required to be fi led      tive is required to sign Part I of this certifi cate.

Probate Court

If an estate tax return    f Upon receipt of one of the above-listed returns for fi ling, the probate court date stamps 
is required to be fi led      both the return and Part I of this certifi cate.

                             Part I is maintained in the court’s public record fi le. Part II of this certifi cate is for-
                             warded to the county auditor with the fi led return or estate tax form 5 for verifi cation 
                             of payment of tax.

                             After receipt of Part II of this certifi cate from the county auditor, the probate court signs 
                             and date stamps Section C. Part II is then fi led with Part I in the public record fi le.

If no estate tax return    f The probate court date stamps Part I of this certifi cate. Part I is then maintained in 
is required to be fi led      the probate court’s public record fi le. Part II is not applicable.

County Auditor

If an estate tax return is f If the estate taxes have been paid in full, the county auditor completes Section B of 
required to be fi led         Part II of this certifi cate to verify that the taxes have been paid in full. The county au-
                             ditor validates the date the return was fi led. Part II of this certifi cate is maintained 
                             at the county auditor’s offi ce until all taxes shown to be due have been paid. 
                             When the taxes are paid, the county auditor signs and date stamps        Part II. After 
                             completion, Part II is returned to the probate court. This same procedure is followed 
                             for nontaxable fi lings.

If no estate tax return    f Neither Part I nor Part II of this certifi cate shall be forwarded to the county auditor’s 
is required to be fi led      offi ce.

Property Description

If an estate tax return is f Attach all real property not listed in the inventory including permanent parcel number, 
required to be fi led         address and full legal description.

If no estate tax return    f Attach a copy of the inventory for the decedent’s estate as well as all real property 
is required to be fi led      not listed on the inventory, including permanent parcel number, address and full legal 
                             description.

                                                                                      ET 22
                                                                                      Rev. 5/12
                                                                                      Page 3

               Certifi cate of Estate Tax Payment and Real Property Disclosure
                  for Dates of Death Nov. 8, 1990 – Dec. 31, 2012
                           (R.C. Section 5731.21)

                           Part II

  A. This section is to be completed by the estate representative.

    Estate of                     Case number

    Date of death                 County

  B. This section is to be completed by the county auditor.

    I hereby verify that the estate taxes shown due on the estate tax return fi led on 
    have been paid in full.
                                                                  Date Tax Paid to
                                                                  County Auditor

    County auditor

 By:
    Deputy  

  C. This section is to be completed by the probate judge.

   The verifi cation of this certifi cate by the county auditor was fi led in this court on the date stamped 
 hereon.
                                                                  Date Filed in
                                                                  Probate Court

    Probate judge

 By:
    Deputy

                                                                                                           ET 22
                                                                                                           Rev. 5/12
                                                                                                           Page 4

                              Instructions for Completion

Estate Representative 

If an estate tax return is f The estate representative completes     Section A in Parts I and II of this certifi cate. 
required to be fi led         The estate representative is required to sign Part I of the certifi cate. Note: For dates 
                             of death Nov. 8, 1990 – Dec. 31, 2012, this certifi cate is required to accompany one 
                             of the following returns when it is fi led with the probate court:
                              (a)  Resident Ohio Estate Tax Return (estate tax form 2)
                              (b)  Nontaxable Return (estate tax form 2)
                              (c)  Ohio Nonresident Estate Tax Return (estate tax form 4)
                              (d)  Amended Resident Ohio Estate Tax Return (estate tax form 2X)

                           f The ET Form 22 will become obsolete for dates of death after Dec. 31, 2012.

If no estate tax return    f The estate representative completes Section B in Part I only. The estate representa-
is required to be fi led      tive is required to sign Part I of this certifi cate.

Probate Court

If an estate tax return    f Upon receipt of one of the above-listed returns for fi ling, the probate court date stamps 
is required to be fi led      both the return and Part I of this certifi cate.

                             Part I is maintained in the court’s public record fi le. Part II of this certifi cate is for-
                             warded to the county auditor with the fi led return or Estate Tax Form 5 for verifi cation 
                             of payment of tax.

                             After receipt of Part II of this certifi cate from the county auditor, the probate court signs 
                             and date stamps Section C.Part II   is then fi led with Part I in the public record fi le.

If no estate tax return    f The probate court date stamps Part I of this certifi cate. Part I is then maintained in 
is required to be fi led      the probate court’s public record fi le. Part II is not applicable.

County Auditor

If an estate tax return is f If the estate taxes have been paid in full, the county auditor completes Section B of 
required to be fi led         Part II of this certifi cate to verify that the taxes have been paid in full. The county au-
                             ditor validates the date the return was fi led. Part II of this certifi cate is maintained 
                             at the county auditor’s offi ce until all taxes shown to be due have been paid. 
                             When the taxes are paid, the county auditor signs and date stamps        Part II. After 
                             completion, Part II is returned to the probate court. This same procedure is followed 
                             for nontaxable fi lings.

If no estate tax return    f Neither Part I nor Part II of this certifi cate shall be forwarded to the county auditor’s 
is required to be fi led      offi ce.

Property Description

If an estate tax return is f Attach all real property not listed in the inventory including permanent parcel number, 
required to be fi led         address and full legal description.

If no estate tax return    f Attach a copy of the inventory for the decedent’s estate as well as all real property 
is required to be fi led      not listed on the inventory, including permanent parcel number, address and full legal 
                             description.