PC-E-1.I (Rev. 12-2000) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE ROBERT G. MONTGOMERY, JUDGE ESTATE OF CASE NO. , DECEASED APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS [R.C. 2113.64] This day the undersigned makes application to the Court for payment of funds deposited for the applicant's benefit. Funds were deposited in Account No. , on . Account transferred to Franklin County Treasurer on in the amount of $ . Applicant states they are the heir for whose benefit said deposit was made. Applicant Address ( ) Telephone Number ENTRY Based upon the above application, the Court finds the applicant is the person entitled to the payment of the funds and hereby: orders the above bank to pay over to them all funds on deposit, upon the signing by the applicant of the proper withdrawal slip and other documents required by the bank. orders the Franklin County Treasurer to issue a check for the amount of $ dollars to be made payable to . LAWRENCE A. BELSKIS Robert G. Montgomery Judge Probate Judge FRANKLIN COUNTY FORM 1.I - APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. RELEASE OF ALL CLAIMS I, Account No. a financial institute. acknowledge receipt of: as issued by . Franklin County check in the amount of $ I hereby knowingly and voluntarily release the Franklin County Probate Judge from all actions, claims, damages and demands whatsoever which I now have or ever had or which my heirs, executor or administrator may have which are associated with the receiving and holding of said funds. Executed this day of , 20 . Applicant Witnesses: American LegalNet, Inc. www.FormsWorkFlow.com