Receipts And Disbursements {13.1}

PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF________________________________________________________, DECEASED CASE NO._______________________________ RECEIPTS AND DISBURSEMENTS [Attach to fiduciary's account] Page 1 of ____ pages. Following is an itemized statement of receipts and disbursements by the fiduciary in the administration of his trust Receipts Disbursements _______________________________________________________________________________________ Item Voucher Value or Value or No. Amount Amount _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Total (page 1) 0.00 0.00 «FT24/2<- PAGE 1 OF FORM LCPC 13.1 MODIFIED ­ RECEIPTS AND DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of ____ pages. Disbursements Receipts _______________________________________________________________________________________ Item Voucher Value or Value or No. Amount Amount _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ I, ______________________, Attorney-at-law, hereby certify, that the within instrument was prepared and/or examined by me, and that the same, in my opinion, is correct and proper. Totals (pages 1 & 2) 0.00 0.00 _________________________________________ Fiduciary PAGE 2 OF FORM LCPC 13.1 MODIFIED ­ RECEIPTS AND DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. Page 3 of ____ pages. Receipts Disbursements _______________________________________________________________________________________ Value or Item Voucher Value or No. Amount Amount _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________