PROBATE COURT OF CUYAHOGA COUNTY, OHIO ANTHONY J. RUSSO, Presiding Judge LAURA J. GALLAGHER, Judge ESTATE OF __________________________________________________________, DECEASED CASE NUMBER ______________________________________ APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION [R.C. 2113.031] Applicant states that 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] The applicant is decedent's surviving spouse entitled to one hundred percent of the allowance for support and decedent's funeral and burial expenses have been prepaid or the surviving spouse has paid or is obligated in writing to pay decedent's funeral and burial expenses and the value of the assets does not exceed the $40,000 allowance for support under R.C. 2106.13(B) plus an amount not exceeding $5,000 for decedent's funeral and burial expenses. The applicant, who is not the surviving spouse, has paid or is obligated in writing to pay decedent's funeral and burial expenses and the value of the assets is the lesser of $5,000 or the amount of decedent's funeral and burial expenses. Attached hereto is a receipt, contract or other document that confirms the applicant’s payment or obligation to pay decedent's funeral and burial expenses or if the applicant is the surviving spouse, the prepayment receipt, if applicable. The decedent's surviving spouse, next of kin, legatees and devisees known to applicant, are listed on attached Form 1.0. Applicant states that there are no pending proceedings for the administration of decedent's estate or relief of decedent's estate from administration under R.C. 2113.03. All known assets with date of death values of the estate are as follows: Motor Vehicles (include year, make, model, body type, manufacturer's vehicle identification number and Certificate of Title number) _______________________________________________________________$_______________ _______________________________________________________________________________ FORM 5.10 - APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION 03/08 American LegalNet, Inc. www.FormsWorkflow.com Accounts maintained by a Financial Institution (include financial institution name and the account's complete identifying number): _______________________________________________________________$_______________ _______________________________________________________________________________ Stocks and Bonds (include for each stock or bond its serial number, the name of its issuer, the name and address of its transfer agent, and the total number of shares of stocks or bonds): _______________________________________________________________$_______________ _______________________________________________________________________________ Real estate described in accompanying Form 12.0 Application for Certificate of Transfer and Form 12.1 Certificate of Transfer and date of death value. [Attach verification of value.] $ Other assets and date of death values _______________________________________________________________$_______________ _______________________________________________________________________________ Total Assets $ _______________ Applicant requests an order granting summary release. _______________________________________ _______________________________ Attorney for Applicant Applicant's Signature _______________________________________ _______________________________ Typed or Printed Name Applicant's Typed or Printed Name _______________________________________ _______________________________ Street Address Street Address _______________________________________ _______________________________ City City State Zip Code State Zip Code _______________________________________ _______________________________ Phone Number (include area code) Phone Number (include area code) Attorney Registration No.__________________________ Signed and acknowledged by the applicant in my presence this ________ day of _______________, 20____ . _______________________________ Notary Public/Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com PROBATE COURT OF CUYAHOGA COUNTY, OHIO ANTHONY J. RUSSO, Presiding Judge LAURA J. GALLAGHER, Judge ESTATE OF __________________________________________________________, DECEASED CASE NUMBER ______________________________________ ENTRY GRANTING SUMMARY RELEASE FROM ADMINISTRATION [R.C.2113.031] The Court finds that the application by ____________________________, satisfies all requirements of R.C. 2113.031 and therefore summarily releases the estate from administration and directs: The delivery to the applicant of decedent's personal property set forth in the application with the title to that property. That Certificate(s) of Transfer, attached to the application, be issued. A certified copy of this order together with a certified copy of the application for this order constitutes sufficient authority for a financial institution, corporation or other entity or person referred to in division (A) to (F) of Section 5731.39 of the Revised Code or for a clerk of a Court of Common Pleas to transfer title to the applicant of an asset of the decedent's estate listed in the application. This order eliminates the need for a financial institution, corporation, or other entity or person to be provided a written consent of the tax commissioner prior to the delivery, transfer, or payment to the applicant of an asset of the decedent's estate listed in the application. This order eliminates the duty of all persons to file an Ohio Estate Tax Return exclusively for the assets listed in the application. _______________________________________ _______________________________ Date PROBATE JUDGE FORM 5.11 - ENTRY GRANTING SUMMARY RELEASE FROM ADMINISTRATION 9/00 American LegalNet, Inc. www.FormsWorkflow.com PROBATE COURT OF CUYAHOGA COUNTY, OHIO ANTHONY J. RUSSO, Presiding Judge LAURA J. GALLAGHER, Judge ESTATE OF __________________________________________________________, DECEASED CASE NUMBER ______________________________________ SURVIVING SPOUSE, CHILDREN, NEXT OF KIN, LEGATEES AND DEVISEES (R.C. 2105.06, 2106.13 2107.19) [Use with those applications or filings requiring some or all of the information in this form, for notice or other purposes. Update as required.] The following are decedent’s known surviving spouse, children, and the lineal descendants of deceased children. If none, the following are decedent’s next of kin who are or would be entitled to inherit under the statutes of descent and distribution. Name Residence Address Relationship To Decedent Birthdate Of Minor Surviving Spouse [Check whichever of the following is applicable] 9 The surviving spouse is the natural or adoptive parent of all of the decedent’s children. 9 The surviving spouse is the natural or adoptive parent of at least one, but not all of decedent’s children. 9 The surviving spouse is not the natural or adoptive parent of any of the decedent’s children. 9 There are minor children of the decedent who are not the children of the surviving spouse. 9 There are minor children of the decedent and no surviving spouse. FORM 1.0 - SURVIVING SPOUSE, CHILDREN, NEXT OF KIN, LEGATEES AND DEVISEES 01/02 American LegalNet, Inc. www.FormsWorkflow.com CASE NUMBER ______________________________ The following are the vested beneficiaries named in the decedent’s Will: Name Residence Address Birth date Of Minor [Check whichever of the following is applicable] 9 The Will contains a charitable trust or a bequest or devise to a charitable trust, subject to R.C. 109.23 to 109.41. 9 The Will is not subject to R.C. 109.23 to 109.41 relating to charitable trusts. __________________________ _____________________________________ Date Applicant (or give other title) _____________________________________ American LegalNet, Inc. www.FormsWorkflow.com