Report On Contents Of A Safe Deposit Box {6.5A}

PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE ESTATE OF ______________________________________________________, DECEASED CASE NO. ________________________________ REPORT ON CONTENTS OF SAFE DEPOSIT BOX ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Date________________________________ __________________________ Commissioner ________________________ Financial Institution _____________________ Applicant 01/03/2012 American LegalNet, Inc. www.FormsWorkFlow.com M.C. FORM 6.5-A ­ REPORT ON CONTENTS OF SAFE DEPOSIT BOX CERTIFICATE OF SERVICE The undersigned Commissioner herby certifies that a copy of this Report has been forwarded by regular U.S. Mail to the following named next of kin or legatees and devisees of the decedent's estate: _________________________________ Commissioner M.C. FORM 6.5-A ­ REPORT ON CONTENTS OF SAFE DEPOSIT BOX 01/03/2012 American LegalNet, Inc. www.FormsWorkFlow.com