Report Of Distribution Of Wrongful Death And Survival Claims
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Report Of Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be use in Franklin County (Court Of Common Pleas).
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Tags: Report Of Distribution Of Wrongful Death And Survival Claims, 14.3, Ohio County (Court Of Common Pleas), Franklin
PC-E-14.3 (Rev. 12-2000)
PROBATE COURT OF FRANKLIN COUNTY, OHIO
JUDGE ERIC BROWN
LAWRENCE A. BELSKIS, JUDGE
ESTATE OF
, DECEASED
CASE NO.
REPORT OF DISTRIBUTION OF
WRONGFUL DEATH AND SURVIVAL CLAIMS
Pursuant to Entry filed
and on the accompanying vouchers.
,
Gross Proceeds
Funeral and burial expenses
Fiduciary fees to
Reimbursement of case expenses to
, the proceeds have been paid as shown below
$
$
$
$
$
$
$
Attorney fees to
Survival claim to the estate
Total Deductions
Net Proceeds
Net Proceeds to beneficiaries:
$
To:
To:
To:
To:
To:
To:
To:
Total payments to beneficiaries
$
$
$
$
$
$
$
$
Balance
-0-
The fiduciary states that there are no other assets remaining in the estate.
The fiduciary states that there are assets remaining in the estate.
Attorney for Fiduciary
Fiduciary
Attorney Registration No.
ENTRY
The above report of the distribution of the proceeds is hereby approved.
There being no further assets to administer, the fiduciary and surety, if any, are discharged.
LAWRENCE A. BELSKIS
Date
Judge
FORM 14.3 - REPORT OF
DISTRIBUTION AND ENTRY
4-97
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