PROBATE COURT OF GEAUGA COUNTY, OHIO JUDGE CHARLES E. HENRY , DECEASED ESTATE OF Case No. APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION [R.C. 2113.03] Applicant states that decedent died on Decedent's domicile was Street Address City or Village or Township if unincorporated area Post Office County State Zip Code [Check on of the following] Decedent's will has been admitted to probate in this Court. To applicant's knowledge, decedent did not leave a will. [Check one of the following] The assets are $15,000 or less and decedent died on or after January 1, 1976. The assets are $25,000 or less and decedent died on or after October 20, 1987. The assets are $35,000 or less and decedent died on or after November 9, 1994. The assets are $50,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after April 16, 1993. The assets are $85,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after September 14, 1993. The assets are $100,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after March 18, 1999. Applicant asks that the estate be relieved from administration because the assets do not exceed the statutory limits. A statement of the assets and liabilities of the estate is listed on the attached Form 5.1. The decedent's surviving spouse, next of kin, legatees, and devisees know to applicant, are listed on the attached Form 1.0. Attorney for Applicant Applicant Type or print name Type or print name Address Address City State Phone Number (include area code) Zip City State Zip Phone number (include area code) Attorney Registration No. 5.0 - APPLICATION TO RELIEVE ESTATE FROM ADMINSTRATION 5/3/99 American LegalNet, Inc. www.FormsWorkFlow.com [Reverse of Form 5.0] WAIVER OF NOTICE The undersigned surviving spouse, heirs at law, legatees, devisees, and other persons entitled to notice of the filing of the application to relieve decedent's estate from administration, waive such notice. ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets , at o'clock for hearing the application to relieve decedent's estate from administration. M., as the date and time [Check one of the following] All notice is dispensed with as unnecessary. Notice by publication to interested parties is dispensed with as unnecessary. Written notice shall be given, as provided by law and the Rules of Civil Procedure, to those persons entitled to notice, who have not waived notice. Written notice is dispensed with as unnecessary. Notice by publication shall be given to interested parties as provided by law and the Rules of Civil Procedure. Written notice shall be given to those persons entitled to notice, who have not waived notice, and notice by publication shall be given to interested parties, as provided by law and the Rules of Civil Procedure. Date Judge, Charles E. Henry American LegalNet, Inc. www.FormsWorkFlow.com