ET 17 
          Department of                  Reset Form                                                Rev. 7/03 
Ohio I    Taxation 
          Estate Tax Unit 
          1-(800) 977-7711 
          tax.ohio.gov 

          Ohio Estate and Additional Tax Estimated Payment Notice 
                               (Ohio Revised Code 5731.23) 

Estate of                                                                   Case number 

To the auditor of                             County

 I, 
                                       Executor, administrator or other person 

hereby make an estimated payment for the estate of the above named decedent who died a resident of 

                                         City, village or township 

                                     Address (including state and ZIP code) 

on the              day of             ,      , in the following amounts:
                               Month     Year 

 Estate tax $ 

                    Interest $

                    Penalty $

 Additional tax $

 Other deficiency                     $ 

                    Total paid       $ 

Date                       ,             Signature 
          Month and day        Year 
   Title 

Note to County Auditor:  An estate tax form 6 (charge) is required to be prepared, processed and forwarded to the Estate 
Tax Unit in Columbus together with a copy of this estate tax form 17 upon fi ling and payment.