PROBATE COURT OF GEAUGA COUNTY, OHIO JUDGE CHARLES E. HENRY ESTATE OF , DECEASED Case No. STATEMENT IN LIEU OF AND FOR AN ACCOUNT [R.C. 2109.30-.14] The undersigned, as of the of being first duly sworn, deposes and says * That no claim is made for expenses or compensation on account of said trust by affiant, other than Wherefore no reasons exist for the continuance of said trust, and resignation as such therefore tenders and asks that the same be accepted by the Court; and that this statement be accepted by the Court in lieu of and for be discharged of Dated account and that said trust , 20 . THE STATE OF OHIO, GEAUGA COUNTY The within named being duly sworn, says that the foregoing statement is true as Sworn to before me and signed in my presence this verily believes. day of , 20 *"That no assets of the estate of said have been collected, and no expenses incurred on behalf thereof since the filing of his account, and that the condition of said estate is the same as stated at the time, for the reason that ." has come to the possession or "That no property or estate of any kind whatsoever belonging to the estate of said knowledge of this affiant as such except ." "That there is no estate of any kind whatsoever, either now or in expectancy, of said , to the knowledge of this affiant ." ." "That said appointment was made for the purpose of said ward has become of full age" or "has died." "That 13 STATEMENT IN LIEU OF ACCOUNT American LegalNet, Inc. www.FormsWorkFlow.com JUDGMENT ENTRY Court of Common Pleas, Probate Division, of Geauga County, Ohio , 20 In the Matter of The ) of Statement in Lieu of and for ) A Account ) This day , as the of said estate, filed a statement in lieu of and for a account of said estate, duly sworn to. The same appearing true and correct, is ordered recorded and the filing of a account is hereby ordered to be dispensed with, and the said hereby discharged from said trust and , is bondsmen released. JUDGE CHARLES E. HENRY American LegalNet, Inc. www.FormsWorkFlow.com