Amended Ohio Estate Tax Resident Return Date Of Death After 6-30-83 {2-X}

ET 2X Rev. 5/12 Estate Tax Unit 1-(800) 977-7711 tax.ohio.gov Amended Ohio Estate Tax Resident Return File in duplicate with the Probate Court. For estates with a date of death of July 1, 1983 ­ Dec. 31, 2012 This form is to be used to report an increase in tax liability, claim a refund or disclose a change with no tax consequences. Check one: Refund Supplemental Tax Nontaxable Disclosure Pay supplemental tax through the county auditor's Office. Estate of: Decedent's last name Decedent's first name and initial Date of death Decedent's Social Security number Case number Address of decedent at time of death (number and street, city, state and ZIP code) County in Ohio, in which Probate Court located, where will probated or estate administered Date estate tax return filed Was it (check one): Taxable Nontaxable If an estate tax form 10, Certificate of Determination of Final Ohio Estate Tax Liability, has been received, attach a copy thereof to this return. Net taxable estate as previously reported .......................................................... Plus additional or increase (or less a decrease) in value of assets (describe on reverse side) ....................................................................................... Total ............................................................................ Less additional or increase (or plus a reduction) in amount of deductions (describe on reverse side) ....................................................................................... New net taxable estate .............................................. Tentative tax due on new net taxable estate (use table on reverse side)................ Less estate tax credit (see reverse side)................................................................. Tax due (subtract line 7 from line 6; if line 7 is more than line 6, enter 0) ......................... Less tax previously assessed or paid (exclude any interest and penalty paid) ............. 1 2 3 4 5 6 7 8 9 $ $ $ $ $ $ $ $ ( $ ) If line 9 is less than line 8, subtract line 9 from line 8 and enter the amount of supplemental tax now due ................................................................................. 10 If line 9 is greater than line 8, subtract line 8 from line 9 and enter the amount of refund now due................................................................................................... 11 Date Filed with Probate Court ( Date Received by Ohio Department of Taxation ) Distribution of Subdivisions' Share of Tax (Ohio Revised Code Section 5731.48 and 5731.50) Percentage City, Village or Township American LegalNet, Inc. www.FormsWorkFlow.com ET 2X Rev. 5/12 Page 2 Explanation of Changes If addtional space is needed, please use attachments. Line 6 ­ Tax Rates If the net taxable estate is: The tax shall be: Not more than $40,000 2% of the net taxable estate More than $40,000, but not more than $100,000 $800 plus 3% of the excess more than $40,000 More than $100,000, but not more than $200,000 $2,600 plus 4% of the excess more than $100,000 More than $200,000, but not more than $300,000 $6,600 plus 5% of the excess more than $200,000 More than $300,000, but not more than $500,000 $11,600 plus 6% of the excess more than $300,000 More than $500,000 $23,600 plus 7% of the excess more than $500,000 Line 7 ­ Credits Date of Death Dates of death on or before 06/30/83 Dates of death 07/01/83, but before 01/01/01 Dates of death 01/01/01, but before 01/01/02 Dates of death 01/01/02, but before 01/01/13 Print or type to expedite audit and finalization Applicable Estate Tax Credit 0 $500 $6,600 $13,900 Declaration Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the deceased's personal representative or person in possession of property is based on all information of which preparer has any knowledge. Name of attorney representing the estate Address (number and street, city, state and ZIP code) Telephone number Name of executor/administrator(s) Address (number and street, city, state and ZIP code) Telephone number Signature of executor/administrator(s) Date Signature of preparer Date File in Duplicate in probate court. American LegalNet, Inc. www.FormsWorkFlow.com