PROBATE COURT OF GEAUGA COUNTY, OHIO TIMOTHY J. GRENDELL, JUDGE ESTATE OF CASE NO. , DECEASED CERTIFICATE OF TRANSFER NO. [Check one of the following] [] [] Decedent died intestate. Decedent died testate. owning the real property described in Decedent died on this certificate. The persons to whom such real property passed by devise, descent or election are as follows: Name Residence Address Transferee's share of decedent's interest [Complete if applicable] The real property described in this certificate is subject to a charge of $ in favor of decedent's surviving spouse, in respect of the unpaid balance of the specific monetary share which is part of the surviving spouse's total intestate share. 12.1 CERTIFICATE OF TRANSFER Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com (Reverse of Form 12.1) CASE NO. The legal description of decedent's interest in the real property subject to this certificate is: [use extra sheets, if necessary]. Prior Instrument Reference: Parcel No: This instrument was prepared by ISSUANCE This Certificate of Transfer is issued this day of 20 . Probate Judge AUTHENTICATION I certify that this document is a true copy of the original Certificate of Transfer No. issued on and kept by me as custodian of the official records of this Court. Date Probate Judge By Deputy Clerk 12.1 ­ CERTIFICATE OF TRANSFER PAGE 2 Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com