PC-E-10.4A (Rev. 12-2000) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY,JUDGE LAWRENCE A. BELSKIS, JUDGE ESTATE OF CASE NO. , DECEASED NOTICE TO DISTRIBUTEE [R.C. 2113.533] To: The undersigned fiduciary is making a distribution to you of assets from the estate prior to the deadline for filing claims against the estate. Distribution will be made after you sign, date and return the Acknowledgment. You may be required to return the distribution or may be liable for repayment of the distribution if a valid claim is later made against the estate within the time permitted under Section 2117.06 of the Revised Code. Fiduciary Typed or Printed Name Address City, State, Zip Code Telephone number (include area code) Date ACKNOWLEDGMENT I acknowledge that I have the above notice and I understand 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. Date Distributee Typed or Printed Name Address City, State, Zip Code Telephone number (include area code) FRANKLIN COUNTY FORM 10.4A - NOTICE TO DISTRIBUTEE American LegalNet, Inc. www.FormsWorkFlow.com