Insolvency Schedule Of Claims {24.4}

PROBATE COURT OF SUMMIT COUNTY, OHIO ESTATE OF: ________________________________________________________, DECEASED CASE NO. ________________________ INSOLVENCY SCHEDULE OF CLAIMS [R.C. 2117.15, 2117.17, 2117.25] The fiduciary states that this Schedule of Claims lists all claims which are presented or secured. The claims are listed by classes and in the order of priority of payment pursuant to Section 2117.25 of the Ohio Revised Code. (Use extra sheets if necessary) ___________________________________ Fiduciary Page _____ of _____ Pages [Note: Include a subtotal following each payment class and a grand total for all payment classes.] _____________________________________________________________________________________ Name and Address of Claimant Payment Class Amount Claimed Estimated Payment Claim Rejected: Y/N _____________________________________________________________________________________ 1. __________________________________________________________________________________ 2. __________________________________________________________________________________ 3. __________________________________________________________________________________ 4. __________________________________________________________________________________ 5. __________________________________________________________________________________ 6. __________________________________________________________________________________ 7. __________________________________________________________________________________ 8. __________________________________________________________________________________ 9. __________________________________________________________________________________ 10. __________________________________________________________________________________ 11. __________________________________________________________________________________ 12. __________________________________________________________________________________ 13. __________________________________________________________________________________ 14. __________________________________________________________________________________ 15. __________________________________________________________________________________ Comments (Refer to Claim Number) ________________________________________________________________________ _____________________________________________________________________________________ Form 24.4 American LegalNet, Inc. www.FormsWorkFlow.com