Assets And Liabilities Of Estate To Be Relieved From Administration {5.1}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::ERIEPROBATE COURT OF COUNTY, OHIOIndex No.Calendar No.ESTATE OF , DECEASED CASE NO. JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATIONFollowing is a summary statement of the character and value of the assets in decedent's estate [Insert a check in the Appraised column opposite an item if it was valued by the appraiser. Leave blank if the readily ascertainable value of the item was determined by applicant. Use extra sheets if necessary.]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Automobiles distributed to surviving spouse by affidavitValueTHE PEOPLE OF THE STATE OF NEW YORK TOFirst automobile selected by surviving spouse under R.C. 2106.18 [Omit value when computing total assets] .............Appraised value $R.C. 2106.18X X X X Second automobile selected by surviving spouse under R.C. 2106.18 [Omit value when computing total assets] .............Appraised value $R.C. 2106.18X X X XGREETINGS:Total value [not to exceed $40,000.00]$X X X XWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableCharacter of assetAppraisedValue Real Estate, described in accompanying Certificate of Transfer No.,$located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomOther assets:$Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Total Assets$4/97FORM 5.1 ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATIONMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Following is a list of decedent's known debts. [Use extra sheets if necessary.]Index No.Calendar No.Name of CreditorNature of DebtJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Amount $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomTotal Debts$Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.CERTIFICATIONThe undersigned appraiser agreed to act as appraiser of decedent's estate, and to appraise the property exhibited truly, honestly, impartially, and to the best of the appraiser's knowledge and ability. The appraiser further says that those assets whose values were not readily ascertainable are indicated above by a check in the Appraised column opposite each such item, and that such values are correct. The undersigned applicant determined the value of those assets whose values were readily ascertainable and were not appraised by the appraiser, and that such values are correct, and to applicant's knowledge the above list of decedent's debts is correct., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressDateTelephone No.: Facsimile No.: E-Mail Address:AppraiserApplicantMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>