PROBATE COURT OF BUTLER COUNTY, OHIO ESTATE OF , DECEASED CASE NO. INVENTORY AND APPRAISAL [R.C. 2115.02 and 2115.09] To the knowledge of the fiduciary the attached schedule of assets in decedent's estate is complete. The fiduciary determined the value of those assets whose values were readily ascertainable and which were not appraised by the appraiser, and that such values are correct. The estate is recapitulated as follows: Tangible personal property ...................................................................................... $ Intangible personal property .................................................................................... $ Real property ........................................................................................................... $ Total ........................................................................................................................ $ First autom obile transferred to surviving spouse under R.C. 2106.18 value $ Second autom obile transferred to surviving spouse under R.C. 2106.18 value $ Total value [not to exceed $40,000.00] $ Insofar as it can be ascertained, an Ohio Estate Tax Return will will not be filed. The fiduciary is also the surviving spouse of the decedent and waives notice of the taking of the inventory. Attorney Fiduciary Attorney Registration No. APPRAISER'S CERTIFICATE The undersigned appraiser agrees to act as appraiser of decedent’s estate and to appraise the property exhibited truly, honestly, impartially, and to the best of the appraiser’s knowledge and ability. The appraiser further says that those assets whose values were not readily ascertainable are indicated on the attached schedule by a check in the “Appraised” column opposite each such item , and that such values are correct. Appraiser FORM 6.0 - INVENTORY AND APPRAISAL - PDF American LegalNet, Inc. www.USCourtForms.com 4/1/2004 CASE NO. WAIVER OF NOTICE OF TAKING OF INVENTORY [R.C. 2115.04] The undersigned surviving spouse hereby waives notice of the time and place of taking the inventory of decedent's estate. Surviving Spouse WAIVER OF NOTICE OF HEARING ON INVENTORY [Use when notice is required by the Court or deemed necessary by the fiduciary] The undersigned, who are interested in the estate, waive notice of the hearing on the inventory. ENTRY SETTING HEARING The Court sets at o'clock .M., as the date and time for hearing the inventory of decedent's estate. Date Probate Judge FORM 6.0 INVENTORY AND APPRAISAL - PAGE 2 American LegalNet, Inc. www.USCourtForms.com