PC-E-5.1C (Rev. 3-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE ROBERT G. MONTGOMERY,JUDGE ESTATE OF CASE NO. , DECEASED APPLICATION FOR RELEASE OF ASSET(S) [NOT TO EXCEED $200.00] , ADDRESS The undersigned states that the above named decedent resided at and died on the NAME day of , Franklin County, Ohio , leaving the following next of kin: RELATIONSHIP Applicant requests the release of $ currently held by of the decedent. (Not to exceed $200.00) in the name of the above decedent, , to the alleged ACKNOWLEDGMENT I acknowledge that I may be required to return any or all of the distribution I receive at this time if a valid claim is filed with the estate in the time allowed by law and the distribution I have received is needed to pay that claim. Witness: Deputy Clerk Applicant's Signature Printed Name Address City, State, Zip Code Telephone Number (include area code) I. D. Number ENTRY The Court has no objection to the distribution of the property in question to the applicant and the Court makes no finding with respect to whom is entitled to the assets. Date LAWRENCE A. BELSKIS Robert G. Montgomery, Judge Judge FRANKLIN COUNTY FORM 5.1C - APPLICATION FOR RELEASE OF ASSET(S) VALUED AT LESS THAN $200.00 American LegalNet, Inc. www.FormsWorkFlow.com