Ohio Application for Certificate of Release of Ohio Estate Tax Lien

Application for Certificate of Release of Ohio Estate Tax Lien
ET_ET21_GEN_050112.indd
Ohio I

ET 21
Rev. 4/12

Depa!1ment of
Taxation

Reset Form

Estate Tax Unit
P.O. Box 183050
Columbus, OH 43218-3050
1-(800) 977-7711
tax.ohio.gov

Date Received by
Ohio Department of Taxation

Application for Certificate of Release of Ohio Estate Tax Lien
For dates of death July 1, 1983 – Dec. 31, 2012
Estate of: Decedent’s last name
County in Ohio

Decedent’s first name and initial
Case number

Date of death

Decedent’s Social Security #

Has an Ohio estate tax
return been filed?



Yes



No

If “yes,” give date it was filed

Name of preparer

Month/Day/Year

Address
Amount of tax paid or to be paid

City, state and ZIP code

$

Telephone number of preparer
Please check the appropriate title (including ancillary executor or administrator):

 Attorney

Executor Administrator(s)

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
Power of appointment property

$

Purchase/sales price on property:

All other property

$

$

Total gross estate

$

J

$

Will the estate be claiming any of the following on the
estate tax return (estate tax form 2):

Debts and expenses of administration

K Charitable deductions

$

L

Marital deduction

$

T

Qualified family-owned business
interest deduction

$

Total deductions (schedules J, K, L and T)

Yes


No


Yes


No


Current agricultural use valuation
(CAUV) per Ohio Revised Code
R.C.) section 5731.011
Extension of time to pay estate tax
per R.C. section 5731.25

$

To be completed by the Ohio Department of Taxation
The application for this release of Ohio estate tax lien is:
Tax commissioner

 Approved

 Not approved
By

Date

ET 21
Rev. 4/12
Page 2

Submit this form in duplicate to: Ohio Department of Taxation
Estate Tax Unit
P.O. Box 183050
Columbus, OH 43218-3050 or
Fax (614) 387-1984
Documents to be attached:
1. Copy of will and letters of administration or testamentary, if
any.

4. Attach a statement of the reasons why you are applying for a
release.

2. Copy of contract of sale, if any.

5. Attach a copy of the latest real estate tax bill received or the
auditor’s tax card.

3. List below a description of the property to which this application
applies, showing the value of the property and the basis of the
valuation. Continue on supplemental sheets, if necessary. Include
parcel number and address of property to be released.
This certificate releases the lien of the state of Ohio imposed by R.C. section 5731.37 on the property described below: