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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 specifi cally 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