FORM 24.0 - REPRESENTATION OF INSOLVENCY E ffect i v e D a t e : J a n u a r y 1 , 20 1 2 PROBATE COURT OF CUY A HOGA COUNTY, OHIO ANTHONY J. RUSSO, PRESIDING JUDGE LAURA J. GALLAGHER, JUDGE ESTATE OF , DECEASED CASE NO. REPRESENTATION OF INSOLVENCY [R.C. 2117.15] The fiduciary states that the decedent died on . The f iduciary states that: there is a surviving spouse and no minor children of the decedent who are not the children of the surviving spouse, and an "Application for Family Allowance" (Standard Probate Form 7.1) has been filed, or there is a surviving sp ouse and minor children of the decedent who are not the children of the surviving spouse and an "Application for Apportionment of Family Allowance"(Standard Probate Form 7.2) has been filed, or there is no surviving spouse and more than one minor child of the decedent and an "Application for Apportionment of Family Allowance" (Standard Probate Form 7.2) has been filed. an election has been made to take the mansion house, other real property and/or tangible personal property as part of the allowance fo r support. It is unnecessary to liquidate these assets. The fiduciary states that the Inventory and Schedule of Assets have been filed and approved. The fiduciary states that the time for filing claims has expired, and that claims against the estate, eit her presented or secured, are in the sum of $ , and there are no known contingent claims. The fiduciary states that the Schedule of Claims is attached, and that all claims have been listed by priority pursuant to R.C. 2117.25. The fiduciary states th at the assets of the estate to the extent necessary have been liquidated. The estate consists of: a mansion house $ . other real property $ . tangible personal property $ . intangible personal property $ . American LegalNet, Inc. www.FormsWorkFlow.com FORM 24.0 - REPRESENTATION OF INSOLVENCY PAGE 2 E ffect i v e D a t e : J a n u a r y 1 , 20 1 2 CASE NO. The fiduciary states that the claims against the estate exceed the assets of the estate and that the estate appears to be insolvent. The fiduciary applies to this Court to set this matter for further hearing and instructions as to the priority of and the payment of claims. Attorney Fiduciary Type d o r Printe d Name Type d o r Printe d Name Addres s Addres s Phon e Numbe r (includ e Are a code) Phon e Numbe r (includ e Are a code) Attorney Registration No. American LegalNet, Inc. www.FormsWorkFlow.com