ET 22 
       Depa!1ment of                                                                                    Rev. 5/12 
Ohio I Taxation 
       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 filed.                                                      required to be filed. 
   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 verifica-
  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 certificate. 
 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 certificate 
  does not take effect until verifi cation of payment of tax is
  received from the county auditor’s offi ce. This certificate 
  does not refl ect the tax commissioner’s final 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 certificate. 
required to be filed          The estate representative is required to sign Part I of the certificate. 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 filed       tive is required to sign Part I of this certificate. 

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 filed       both the return and Part I of this certificate. 

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

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

If no estate tax return    f The probate court date stamps Part I of this certificate. Part I is then maintained in 
is required to be filed       the probate court’s public record file. 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 filed          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 filed.  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 filings. 

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 filed       office. 

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 filed          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 filed       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 verification of this certificate by the county auditor was filed 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 certificate. 
required to be filed          The estate representative is required to sign Part I of the certificate. 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 filed       tive is required to sign Part I of this certificate. 

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 filed       both the return and Part I of this certificate. 

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

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

If no estate tax return    f The probate court date stamps Part I of this certificate. Part I is then maintained in 
is required to be filed       the probate court’s public record file. 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 filed          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 filed.     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 filings. 

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 filed       office. 

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 filed          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 filed       not listed on the inventory, including permanent parcel number, address and full legal 
                             description.