Ohio Close Corporation Valuation Form

Close Corporation Valuation Form
ET_ET18_FI_063011.indd
Ohio I

ET 18
Rev. 7/03

Department of
Taxation

Reset Form

Estate Tax Unit
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

County in Ohio

Decedent’s first name and initial

Case number

Date of death

Decedent’s Social Security number

Name of corporation

Item I. Preferred Stock
The number of shares of preferred stock owned by decedent
pany’s preferred stock per share for the past five years are as follows:
Year ending

Dividends per share

. The book values and dividends of said com-

Book value per share

Based on following number
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
pany’s common stock per share for the past five years are as follows:
Year ending

Dividends per share

The common stock has a par value of $

. The book values and dividends of said com-

Book value per share

per share.

Based on following number
of shares then outstanding

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Rev. 7/03
Page 2

Item III. Statement of Earnings
The following is a statement of the profit 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:
Net profit (or loss)a

Year ending

(a)

Do not deduct any dividends paid during year.

(b)

Based on following number
of shares then outstanding

Earnings per shareb

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
Common/Preferred

Number

Date

Seller

Price

Broker

Buyer

Item V. Incorporation Data
Incorporated under the state of

When

Principal place of business (street address, city, state, ZIP code)

I

Nature of business (If additional space is needed, use Additional Comments section on page 3.)
President
Vice president
Treasurer
Secretary

being first 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
Sworn to and subscribed before me this

day of

Title
, 20

Notary public

.

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Rev. 7/03
Page 3

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 Classification System) code:
Briefly summarize:
1. Company operations

2. Company history and present status

3. Economic outlook of industry

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Rev. 7/03
Page 4

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