Application For Summary Realease From Administration {5.10}

PROBATE COURT OF SUMMIT COUNTY, OHIO ESTATE OF ________________________________________________, DECEASED CASE NO. __________________________ APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION (R.C. 2113.031) Applicant states that decedent died on __________________________________________. Decedent's domicile was _____________________________________________________ Street Address __________________________________________________________________________ City, Village, or Township if unincorporated area County __________________________________________________________________________ Post Office State Zip Code (Check one of the following): The applicant is decedent's surviving spouse entitled to one hundred percent of the allowance for support and decedent's funeral and burial expenses have been prepaid or the surviving spouse has paid or is obligated in writing to pay decedent's funeral and burial expenses and the value of the assets does not exceed the $40,000 allowance for support under R. C. 2106.13(B) plus an amount not to exceed $5,000 for decedent's funeral and burial expenses. The applicant, who is not the surviving spouse, has paid or is obligated in writing to pay decedent's funeral and burial expenses and the value of the assets is the lesser of $5,000 or the amount of decedent's funeral and burial expenses. Attached hereto is a receipt, contract, or other document that confirms the applicant's payment or obligation to pay decedent's funeral and burial expenses or if the applicant is the surviving spouse, the prepayment receipt, if applicable. The decedent's surviving spouse, children, next of kin, legatees and devisees known to applicant, are listed on the attached Form 1.0. Applicant states that there are no pending proceedings for the administration of decedent's estate or relief of decedent's estate from administration under R.C. 2113.03. All known assets with date of death values of the estate are as follows: Motor Vehicles (include year, make, model, body type, manufacturer's vehicle identification number and Certificate of Title number) ____________________________________________________ $_____________________ ____________________________________________________ $_____________________ Form 5.10 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. Accounts maintained by a Financial Institution (include financial institution name and the last four digits of the account number): ___________________________________________________ ___________________________________________________ $___________________ $___________________ Stocks and Bonds (include for each stock and bond its serial number, the name of its issuer, the name and address of its transfer agent, and the total number of shares of stocks or bonds): ___________________________________________________ ___________________________________________________ $___________________ $___________________ Real estate described in accompanying Form 12.0 Application for Certificate of Transfer and Form 12.1 Certificate of Transfer and date of death value. (Attach verification of value.) $___________________ Other assets and date of death values: ___________________________________________________ ___________________________________________________ Total Assets Applicant requests an Order granting Summary Release. ______________________________________ Attorney for Applicant ______________________________________ Typed or Printed Name ______________________________________ Address ______________________________________ City State Zip ______________________________________ Phone Number (include area code) ______________________________________ Supreme Court Registration Number __________________________________________ Applicant __________________________________________ Typed or Printed Name __________________________________________ Address __________________________________________ City State Zip __________________________________________ Phone Number (include area code) $___________________ $___________________ $___________________ Signed and acknowledged by the applicant in my presence this ____ day of _____________________, 20___. _________________________________________ Notary Public/Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com