ET 18 
               Department of                                                                                    Rev. 7/03 
Ohio        I  Taxation 
               Estate Tax Unit                      Reset Form
               P.O. Box 183050 
               Columbus, OH 43218-3050 
               1-(800) 977-7711 
               tax.ohio.gov 

                                 Close Corporation Valuation Form 

Estate of: Decedent’s last name             Decedent’s fi rst name and initial  Date of death 

County in Ohio                  Case number                                   Decedent’s Social Security number 

Name of corporation 

Item I. Preferred Stock 
The number of shares of preferred stock owned by decedent                     . The book values and dividends of said com-
pany’s preferred stock per share for the past fi ve years are as follows: 

                                                                               Based on following number 
Year ending                     Dividends per share       Book value per share 
                                                                               of shares then outstanding 

The preferred stock has a par value of $            per share. The nominal dividend rate is    %. It is cumulative , 
noncumulative , participating . The amount of accumulated dividends as of the date of death on the above preferred 
stock was $             . This stock is callable , noncallable . 

Item II. Common Stock 
The number of shares of common stock owned by decedent                       . The book values and dividends of said com-
pany’s common stock per share for the past fi ve years are as follows: 

                                                                               Based on following number 
Year ending                     Dividends per share       Book value per share of shares then outstanding 

The common stock has a par value of $               per share. 

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Item III. Statement of Earnings 
The following is a statement of the profi  t or loss (after income tax but before dividends) for the last five years indicated and 
also a statement representing earnings per share for said common stock: 
       Year ending                  Net profi t (or loss)a           Earnings per shareb         Based on following number 
                                                                                                of shares then outstanding 

(a)Do not deduct any dividends paid during year. (b)  To arrive at the earnings per share for common stock, deduct dividend requirements of preferred  
                                                   stock and divide remainder by the number of shares of common stock then outstanding. 
Item IV. Sales Evidence 
The following is a list of the sales of the corporate stock, made within a reasonable period of time prior to and/or after the 
date of death. 

                    Shares Sold 
                                                                      Seller                Buyer                  Broker 
   Common/Preferred Number          Date             Price 

Item V. Incorporation Data
Incorporated under the state of                                                  When 
                                                                                 I 
Principal place of business (street address, city, state, ZIP code) 

Nature of business (If additional space is needed, use Additional Comments section on page 3.) 

President 

Vice president 

Treasurer 

Secretary 

                                                     being fi rst duly sworn deposes and says that he/she is the     President, 
  Vice president,    Treasurer,    Secretary of the corporation and that he/she has examined the books and records 
of said company that disclose the above facts; that the same represents a true copy of the records of said corporation.

       Signature of officer    Title                                           

Sworn to and subscribed before me this                  day of                          , 20              .

       Notary public 

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Additional comments 

Item VI. Additional Information 
This information is needed in order to make a fair evaluation of the corporation. 
The appropriate NAICS (North American Industry Classifi cation System) code: 

Briefl y summarize: 
1. Company operations 

2. Company history and present status 

3. Economic outlook of industry 

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4. Share of market 

5. Economic outlook of status of business 

Item VII. Method Used in Valuation 

Please provide a detailed outline of the valuation method