PROBATE COURT OF CUYAHOGA COUNTY, OHIO ANTHONY J. RUSSO, Presiding Judge LAURA J. GALLAGHER, Judge ESTATE OF _______________________________________________________________, DECEASED CASE NUMBER:_____________________________ APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION (R.C. 2113.03) Applicant states that decedent died on _______________________________________________________________________ Decedent's domicile was___________________________________________________________________________________ Street Address _______________________________________________________________________________________________________ City or Village, or Township if unincorporated area Post Office State County Zip Code _______________________________________________________________________________________________________ (Check one of the following) G G G G G G G G Decedent's will has been admitted to probate in this Court. To applicant's knowledge, decedent did not leave a Will. (Check one of the following) The assets are $15,000 or less and decedent died on or after January 1, 1976. The assets are $25,000 or less and decedent died on or after October 20, 1987. The assets are $35,000 or less and decedent died on or after November 9, 1994. The assets are $50,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after April 16, 1993. The assets are $85,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after September 14, 1993. The assets are $100,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after March 18, 1999. Applicant asks that the estate be relieved from administration because the assets do not exceed the statutory limits. A statement of the assets and liabilities of the estate is listed on the attached Form 5.1. The decedent's surviving spouse, next of kin, legatees, and devisees known to applicant, are listed on the attached Form 1.0. (Check, if applicable) G Decedent was fifty-five years of age or older at the time of death and was a recipient of medical assistance under chapter 5111 of the Revised Code. Form 7.0 Notice to Administrator of Estate Recovery Program has been or will be fi led. ____________________________________________ Applicant _______________________________________________ Attorney For Applicant _______________________________________________ Typed or Printed Name ____________________________________________ Typed or Printed Name _______________________________________________ Address ____________________________________________ Address _______________________________________________ _______________________________________________ Phone Number (include area code) ____________________________________________ ____________________________________________ Phone Number (include area code) Attorney Registration No. __________________________ FORM 5.0 - APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION 3/99 American LegalNet, Inc. www.FormsWorkflow.com WAIVER OF NOTICE The undersigned surviving spouse, heirs at law, legatees, devisees and other persons entitled to notice of the filing of the application to relieve decedent's estate from administration, waive such notice. ________________________________________ ________________________________________ ________________________________________ ________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets ____________________________, at _________ o'clock __. M, as the date and time for hearing the application to relieve decedent's estate from administration. [Check one of the following] G G G G All notice is dispensed with as unnecessary. Notice by publication to interested parties is dispensed with as unnecessary. Written notice shall be given, as provided by law and the Rules of Civil Procedure, to those persons entitled to notice, who have not waived notice. Written notice is dispensed with as unnecessary. Notice by publication shall be given to interested parties as provided by law and the Rules of Civil Procedure. Written notice shall be given to those persons entitled to notice, who have not waived notice, and notice by publication shall be given to interested parties, as provided by law and the Rules of Civil Procedure. ________________________________________ Date _________________________________________ Probate Judge 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 NO. __________________________________ 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 Surviving Spouse Birthdate of Minor [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 NO. _______________________________ The following are the vested beneficiaries named in the decedent's Will: Name Residence Address Birthdate of Minor [Check whichever of the following is applicable] 9 9 Date The Will contains a charitable trust or a bequest or devise to a charitable trust, subject to R.C. 109.23 to 109.41. The Will is not subject to R.C. 109.23 to 109.41 relating to charitable trusts. _______