Application To Relieve Estate From Administration (Trumbull) {5.0}

PROBATE COURT OF TRUMBULL COUNTY, OHIO -$0(6 $ )5('(5,&.$, JUDGE ESTATE OF _________________________________________________________, DECEASED CASE NO. _____________________ APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION [R.C. 2113.03] Applicant states that the decedent died on _______________________________________________ Decedent's domicile was ___________________________________________________________________ Street Address ________________________________________________________________________________________________ City or Village, or Township if unincorporated area County ________________________________________________________________________________________________ Post Office State Zip Code [Check one of the following] Decedent's will has been admitted to probate in this Court. To applicant's knowledge, decedent did not leave a will. [Check one of the following] The assets are $15,000 or less and decedent died on or after January 1, 1976. The assets are $25,000 or less and decedent died on or after October 20, 1987. The assets are $35,000 or less and decedent died on or after November 9, 1994. The assets are $50,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after April 16, 1993. The assets are $85,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after September 14, 1993. The assets are $100,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after march 18, 1999. [Check, if applicable] Decedent was fifty-five years of age or older at the time of death and was a recipient of medical assistance under Chapter 5111 of the Revised Code. SPF 7.0 Notice to Administrator of Estate Recovery Program has been filed. Applicant asks that the estate be relieved from administration because the assets do not exceed the statutory limits. A statement of the assets and liabilities of the estate is listed on the attached Form 5.1. The decedent's surviving spouse, next of kin, legatees and devisees known to applicant, are listed on attached form 1.0. ________________________________________________ _______________________________________________________ Attorney for Applicant ________________________________________________ Applicant's Signature _______________________________________________________ Typed or Printed Name ________________________________________________ Applicant's Typed or Printed Name _______________________________________________________ Street Address ________________________________________________ City State Zip Code ________________________________________________ Street Address _______________________________________________________ City State Zip Code _______________________________________________________ Phone Number (include area code) Attorney Registration No. __________________ Phone Number (include area code) FORM 5.0 APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com 9/26/03 Case No. ____________________________ WAIVER OF NOTICE The undersigned surviving spouse, heirs at law, legatees, devisees, and other persons entitled to notice of the filing of the application to relieve decedent's estate from administration, waive such notice. ________________________________________ ________________________________________ ________________________________________ ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets ___________________________________________, at ____________o'clock ___. M. , as the date and time for hearing the application to relieve decedent's estate from administration. [Check on of the following] All notice is dispensed with as unnecessary. Notice by publication to interested parties is dispensed with as unnecessary. Written notice shall be given, as provided by law and the Rules of Civil Procedure, to those persons entitled to notice, who have not waived notice. Written notice is dispensed with as unnecessary. Notice by publication shall be given to interested parties as provided by law and the Rules of Civil Procedure. Written notice shall be given to those persons entitled to notice, who have not waived notice, and notice by publication shall be given to interested parties, as provided by law and the Rules of Civil Procedure. _________________________________________ Date _____________________________________________ -DPHV $ )UHGHULFND Probate Judge FORMFORM 5.0 APPLICATION SUMMARY RELEASE FROM ADMINISTRATION 5.10-APPLICATION FOR TO RELIEVE ESTATE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com 7/9/01 9/26/03