PC-MS-22.4A (Rev. 10-2015) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE IN THE MATTER OF CASE NO. MINOR REPORT OF DISTRIBUTION Pursuant to Entry filed on the accompanying vouchers. Gross Proceeds Less: Medical expenses Reimbursement of suit expenses to $ Attorney fees to Loss of service to Other: Total Net Proceeds Deposited pursuant to R.C. 2109.13 Form 22.3 attached Delivered to legal guardian of the estate Delivered to parent and natural guardian Delivered to the person by whom the minor is maintained Structured - see documents previously filed Balance , , , $ $ $ $ $ , , the proceeds have been paid as shown below and $ $ $ $ $ $ $ -0- Filer is responsible for uploading proposed Entry Approving Report of Distribution - Form 22.4Ee. Attorney for Fiduciary Attorney Registration No. FORM MS-22.4 - REPORT OF DISTRIBUTION Fiduciary American LegalNet, Inc. www.FormsWorkFlow.com