ET 5
                                                                                                                  Rev. 7/03
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              Estate Tax Unit
              1-(800) 977-7711
              tax.ohio.gov

                 Ohio Estate and Additional Tax Return Filing Notice
    This form should not be sent to the Estate Tax Unit in Columbus. File with the probate court.

Estate of: Decedent’s last name           Decedent’s fi rst name and initial     Case number

Date of death                             Address of decedent at time of death (city, village or township)

If nonresident, where in Ohio is property located? 

I,                                                 probate judge of                                          Ohio, do
                                                                                County

hereby give notice that on                         ,  
                                    Date                                        Executor/administrator

has fi led the following:

     Estate Tax Return (estate tax form 2)                            Nonresident Tax Return (estate tax form 4)

     Amended Tax Return (estate tax form 2X)                          Additional Tax Return (estate tax form 3 or 3N)

   This return indicates a tax due of $                              Other  

                                                   Distribution

   Date of Death: On or After             Date of Death: Jan. 1, 2001 –         Date of Death: July 1, 1983 –
    Jan. 1, 2002                                   Dec. 31, 2001                 Dec. 31, 2000

   State of Ohio             –  20%                State of Ohio     –      30% State of Ohio             –  36%
   Local subdivisions  –        80%                Local subdivisions   –   70% Local subdivisions  –        64% 

                                                                                Probate judge

                                                                  By                                              Deputy