ASSETS AND LIABILITIES OF ESTATE TO BERELIEVED FROM ADMINISTRATIONFRANKLIN COUNTY FORM FORM E-5.1 - ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATION(PAGE 1)Following is a summary statement of the character and value of the assets in decedent's estate.[Insert a check in the "Appraised" column opposite an item if it was valued by the appraiser. Leave blank if the readily ascertainable value of the item was determined by applicant. Use extra sheets if necessary]Automobiles distributed to surviving spouse by affidavit.Automobile values transferred to surviving spouse under R.C. 2106.18:1. $ 2. $ 3. $ 4. $ Total value not to exceed $65,000 [or $40,000 for dates of death before April 6, 2017] $ AppraisedValueCharacter of AssetReal Estatedescribed in accompanying certificate of transfer No. ....... .......$ Other assets [List the institution, the last four digits only of each account number and the type of account.] ....... .......$ ....... .......$ ....... .......$ ....... .......$ ....... .......$ ....... .......$ ....... .......$ ....... .......$ Total Assets........................................................................................................................ $ PC-E-5.1 (Rev. 7-2017)PROBATE COURT OF FRANKLIN COUNTY, OHIOROBERT G. MONTGOMERY, JUDGEESTATE OF , DECEASEDCASE NO. American LegalNet, Inc. www.FormsWorkFlow.com en-USFollowing is a list of decedent's known debts. en-US[Use extra sheets if necessary] Name of Creditor þ Nature of Debt þ Amount en-USThe undersigned appraiser agreed to act as appraiser of decedent's estate, and to appraise the property en-USexhibited truly, honestly, impartially, and to the best of the appraiser's knowledge and ability. The appraiser furen-US-en-USther says that those assets whose values were not readily ascertainable are indicated above by a check in the en-US"Appraised" column opposite each such item, and that such values are correct.en-USThe undersigned applicant determined the value of those assets whose values were readily ascertainable and were en-USnot appraised by the appraiser, and that such values are correct, and to applicant's knowledge the above list of en-USdecedent's debts is correct. en-USDateen-USAppraiser en-USApplicanten-USCERTIFICATIONen-USCASE NO. þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ þ. .... þ $ en-USTotal Debts þ. ...................................................................................................................................... þ en-US$ en-USFRANKLIN COUNTY FORM FORM E-5.1 - ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATIONen-US(PAGE 2) American LegalNet, Inc. www.FormsWorkFlow.com