ET 17
                                        Reset Form                                                 Rev. 7/03

            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 defi ciency                    $

                    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.