PC-T-25.5A (Rev. 4-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE ROBERT G. MONTGOMERY,JUDGE IN THE MATTER OF THE WRONGFUL DEATH TRUST INTER VIVOS TRUST TESTAMENTARY TRUST SPECIAL NEEDS TRUST OF CASE NO. DECEASED, GRANTOR TRUSTEE'S ACCOUNT [R.C. 2109.30] Account From Date 20 (Balance from previous account or inventory) Voucher No. $ $ To FRANKLIN COUNTY FORM 25.5A - TRUSTEE'S ACCOUNT American LegalNet, Inc. www.FormsWorkFlow.com Case No. RECAPITULATION Total Receipts Total Disbursements Balance $ $ Remaining $ ITEMIZED STATEMENT OF ALL REMAINING FUNDS, ASSETS AND INVESTMENTS Item $ Attorney Trustee Supreme Court Registration No. Address City, State, Zip Code ( ) Telephone Number ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets at o'clock m. as the date and time for hearing the above accounting and orders notice of the hearing to be given as provided by law and Rules of Civil Procedure. Date LAWRENCE A. BELSKIS ROBERT G. MONTGOMERY Probate Judge Judge American LegalNet, Inc. www.FormsWorkFlow.com