PC-EGT-10.D (Rev. 1-2016) PROBATE COURT OF FRANKLIN COUNTY, OHIO ESTATE OF GUARDIANSHIP OF TRUST OF CASE NO. ROBERT G. MONTGOMERY, JUDGE INCOMPETENT , DECEASED APPLICATION TO DEPOSIT UNCLAIMED FUNDS INTO THE FRANKLIN COUNTY, OHIO, TREASURY [RC 2113.64] This day the undersigned Applicant, Print or Type Name (Fiduciary / Attorney), in the above matter makes application to deposit funds belonging to the person or creditor set forth below, to the County Treasury pursuant to R.C. 2113.64. Your Applicant states that: the funds have remained unclaimed and the Final Account is ready to be filed and further, that the applicant has used all reasonable diligence to locate and to notify such person or creditor that funds are owed to such person or creditor from this estate. the Fiduciary/Attorney has attempted to pay the funds to the person or creditor but the person or creditor has not endorsed such payment or has otherwise refused to accept the delivery of such payment. PERSON OR CREDITOR ADDITIONAL INFORMATION REQUIRED Print or type the following requested information here. Full Name of person: Last known address: City, State, Zip code: Last known place of employment: Address: City, State, Zip Code: FRANKLIN COUNTY FORM EGT-10.D - APPLICATION TO DEPOSIT UNCLAIMED FUNDS (PAGE 1) American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. 1. Whatwastherelationshipofthepersontothedecedent?Bespecific,maternal,paternal,etc. 2. What actions have been taken to locate the person? 3. Wasthereaspecialrelative,friendoremployerwhomayassistinfindingthisperson? 4. Who can identify the person or authenticate his/her identity, if the person is found? Dollar Amount of Funds to be Deposited: $ Attorney for Estate: Attorney Registration Number: Print or Type Name Wherefore, the Applicant requests an order authorizing the above funds to be deposited into the Franklin County, Ohio, Treasury. Submitted By: Typed or Printed Name Applicant's Signature Address City, State, Zip Code Telephone Number (include area code) E-mail FRANKLIN COUNTY FORM EGT-10.D - APPLICATION TO DEPOSIT UNCLAIMED FUNDS (PAGE 2) American LegalNet, Inc. www.FormsWorkFlow.com