PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE IN THE MATTER OF CASE NO. REPORT OF DISTRIBUTION MINOR'S CLAIM Pursuant to Entry filed paid as shown below and on the accompanying vouchers. Gross Proceeds Less: Medical expenses Reimbursement of suit expenses to $ Attorney fees to Loss of service to Others: Total Net Proceeds Deposited pursuant to R. C. 2111.05 Form 22.3 attached Delivered to legal guardian of the estate Delivered to parent and natural guardian Delivered to the person by whom the minor is maintained Structured - see documents previously filed Balance Attorney for Applicant Attorney Registration No. Applicant $ $ $ $ $ $ $ , the proceeds have been $ $ $ $ $ -0- ENTRY The above report of distribution is hereby approved and the applicant is discharged from further responsibility. Date Ralph Winkler, Probate Judge FORM 22.4 - REPORT OF DISTRIBUTION AND ENTRY MINOR'S CLAIM 04/01/97 American LegalNet, Inc. www.FormsWorkFlow.com