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                                                                                                           ET Schedule I 
Estate of:                                                                                                 Rev. 1/04 
                                                Ohio Estate Tax Return 
                      Schedule I – Annuities, Pensions, Retirement and 
                                  Other Employer Death Benefi t Plans 
                                   (Jointly owned property must be listed on Schedule E) 

All annuity interests held by the decedent must be shown.    Teachers Insurance and Annuity Association (TIAA) and        
List payments under commercial annuity contracts, IRA’s      College Retirement Equity Fund (CREF) benefi ts are     not 
or similar contracts, all employer bonus plans, deferred     exempt from taxation. These funds do not fall into the same 
compensation contracts and employer death benefi t plans,     category as the State Teachers Retirement System and         
unless specifically excluded under O.R.C. Section 5731.09.    therefore must be included under this schedule. For further 
                                                             information, please refer to E.T. Bulletin 1, revised 3/97. 
Effective for dates of death on or after March 7, 1997, and 
to the extent documentation is provided, the value of the 
gross estate shall not include that portion of an annuity or 
other death benefi t plan contributed by decedent’s employer. 

Item                                                         Alternate             Alternate       Value at Date 
Number                        Description                    Valuation Date              Value         of Death 

                                    Calculation of Annuity(s) 

    1.                                                                       $                    $

    2. 

    3. 

    4. 

    5. 

    6. 

Total (also enter on Recapitulation of Assets, page 2) 

                                                   Schedule I