PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE ESTATE OF CASE NO. , DECEASED CERTIFICATE OF TRANSFER [Check one of the following] Decedent died intestate. Decedent died testate. Decedent died on owning the real property described in this certificate. The persons to whom such real property passed by devise, descent or election are as follows: NO. 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. Page 1 of 2 S.P. FORM 12.1 - CERTIFICATE OF TRANSFER 02/19/14 American LegalNet, Inc. www.FormsWorkFlow.com 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 , . James Cissell, Probate Judge AUTHENTICATION I certify that the above document is a true copy of the original Certificate of Transfer No. and kept by me as custodian of the official records of this Court. issued on Date Ralph Winkler, Probate Judge By: Deputy Clerk Page 2 of 2 S.P. FORM 12.1 - CERTIFICATE OF TRANSFER American LegalNet, Inc. www.FormsWorkFlow.com