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              Department of                                                                                      Rev. 7/03 
Ohio I        Taxation                              Reset Form
              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