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Department of the Treasury - Internal Revenue Service Transfer Certificate Form 5173 (Rev. July 2008) ESTATE OF DATE OF DEATH RESIDENCE AT TIME OF DEATH By direction of the Commissioner of Internal Revenue, and in accordance with provisions of internal revenue laws and regulations, I hereby certify that any estate tax on the above-named estate has been discharged or provided for, and that the property described below may be transferred without liability under Federal estate tax law and regulations. DATE International Cincinnati Campus Compliance Services ORGANIZATION: DIRECTOR (signature) Cat. No. 42322V Form 5173 (Rev. 7-2008)
