Application For Certificate Of Release Of Ohio State Tax Lien {21}

ET 21 Rev. 4/12 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 Case number Decedent's first name and initial Decedent's Social Security # Date of death Has an Ohio estate tax return been filed? Name of preparer Address City, state and ZIP code Telephone number of preparer Please check the appropriate title (including ancillary executor or administrator): Attorney Yes No If "yes," give date it was filed Month/Day/Year Amount of tax paid or to be paid $ 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 Schedule A Real estate Schedule E Jointly owned property Schedule G Transfers during decedent's life Schedule H Power of appointment property All other property Total gross estate J Debts and expenses of administration $ $ $ $ $ $ $ $ $ $ $ Yes No Name and address of the purchaser, transferee or mortgagee and state relation to applicant decedent. Purchase/sales price on property: $ Will the estate be claiming any of the following on the estate tax return (estate tax form 2): Yes No K Charitable deductions L T Marital deduction Qualified family-owned business interest deduction 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 Total deductions (schedules J, K, L and T) 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 American LegalNet, Inc. www.FormsWorkFlow.com 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. 2. Copy of contract of sale, if any. 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: 4. Attach a statement of the reasons why you are applying for a release. 5. Attach a copy of the latest real estate tax bill received or the auditor's tax card. American LegalNet, Inc. www.FormsWorkFlow.com