PROBATE COURT OF BUTLER COUNTY, OHIO DISINTERMENT OF , DECEASED CASE NO. APPLICATION FOR ORDER TO DISINTER REMAINS [R.C. 517.24 AND 517.25] Applicant says that the decedent died on , and is buried in Cemetery, Butler County, Ohio. Applicant says that (s)he is eighteen years of age or older and of sound mind, and did [ ] or did not [ ] assume financial responsibility for the funeral of the decedent. The relationship of Applicant to the decedent is . Applicant says that disinterment would not be against the religious beliefs of the decedent. Applicant asks to reinter remains in Cemetery. Applicant [ ] has secured [ ] will secure a permit [R.C. 517.23(B)] from the Board of Health (or other authorized agency) which shall state whether the decedent died of a contagious or infectious disease and whether disinterment is permissible. Check whichever of the following are applicable: [ ] To applicant’s knowledge, decedent did not leave a W ill. [ ] Decedent’s W ill has been admitted to probate in this Court Attached is a list of the surviving spouse, next of kin, legatees and devisees known to the applicant, which list includes those persons entitled to notice of the application for disinterment. Attorney for Applicant Applicant Typed or Printed Name Typed or Printed Name Address Address Phone Number (include area code) Phone Number (include area code) Attorney Registration No. Sworn to and subscribed in my presence this day of , . Notary Public BCPC FORM 381 - APPLICATION FOR ORDER TO DISINTER REMAINS 10/97 American LegalNet, Inc. www.FormsWorkFlow.com