PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF CASE NO. ______________________ ENTRY APPOINTING SPECIAL ADMINISTRATOR; LETTERS OF AUTHORITY [R.C. 2113.15 ­ 2113.17] & [R.C. 2109.08] Name of Fiduciary: Title of Fiduciary: Special Administrator On hearing in open Court the application of the above fiduciary for authority to administer decedent's estate (until an executor or administrator is hereinafter appointed), the Court finds that; Decedent died [check one of the following] domiciled in [Check one of the following] Bond is dispensed with by the Will Bond is dispensed with by law has executed and filed an appropriate bond, which is approved by the Court (see also R.C. 2109.08); and: Applicant is a suitable and competent person to execute the trust. The Court therefore appoints applicant as such Special Administrator, with the power conferred by law to administer decedent's estate. This entry of appointment constitutes the fiduciary's letters of authority. It is further ordered that the Special Administrator shall file with the Probate Court within three (3) months or upon appointment of the executor or administrator, whichever is sooner, an inventory of decedent's interest in real estate located within this state and of the tangible and intangible personal property of the decedent that has come into the Special Administrator's possession or knowledge. It is further ordered that the Special Administrator shall file with the Probate Court within six (6) months or upon appointment of the executor or administrator, whichever is sooner, an accounting of the tangible and intangible personal property of the deceased, decedent's interest in real estate located within this state, and for the debts of the deceased that the Special Administrator receives as Special Administrator. , DECEASED testate intestate ­ on . , Applicant NOTICE TO FINANCIAL INSTITUTIONS Funds being held in the name of the within-named Decedent shall not be released to Special Administrator without a Court Order directing release of a specific fund and amounts thereof. Date Judge Jack R. Puffenberger CERTIFICATE OF APPOINTMENT AND INCUMBENCY The above document is a true copy of the original kept by me as custodian of the records of this Court. It constitutes the appointment and letters of authority of the named fiduciary, who is qualified and acting in such capacity. Probate Judge/Clerk «FT5/6TQB@ [Seal] By Date FORM LCPC ES4.5SPA­ ENTRY APPOINTING SPECIAL ADMINISTRATOR; LETTERS OF AUTHORITY American LegalNet, Inc. www.FormsWorkFlow.com EFF: 09/22/2009