PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF ______________________________________________________, DECEASED CASE NO. ______________________ REPORT ON CONTENTS OF SAFE DEPOSIT BOX The following items constitute the contents of Safe Deposit Box Number located at at the following address , , . , Ohio Will(s) and Codicil(s) removed from safe deposit box and delivered to the Court. Contents of safe deposit box included the following personal property of the decedent, which is deemed to be subject to probate administration: Contents of safe deposit box included the following personal property of the decedent, which is deemed not subject to probate administration: No contents. Other – Specify: Please attach additional sheets if applicable Date Financial Institution Commissioner By: Authorized Officer Typed or Printed Name Phone Number LCPC FORM 2.8RPT – REPORT ON CONTENTS OF SAFE DEPOSIT BOX EFF: 09/22/2009 American LegalNet, Inc. www.FormsWorkFlow.com