MARK J. BARTOLOTTA, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO ESTATE OF ___________________________________________________________, DECEASED CASE NO. ______________________ APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE [R.C. 2109.02 and 2109.07] [For Executors and all Administrators; attach supplemental Application for ancillary administration, if applicable] The applicant states that decedent died on_________________________________________________ Decedent's domicile was ______________________________________________________________ Street Address __________________________________________________________________________________ City or Village, or Township if unincorporated area County ______________________________________________________________________________________________________________ Post Office State Zip Code Applicant asks to be appointed__________________________________________________________ of decedent's estate. [Check whichever of the following are applicable] To applicant's knowledge, decedent did not leave a Will Decedent's Will has been admitted to probate in this Court A supplemental application for ancillary administration is attached. Attached is a list of the surviving spouse, children, next of kin, and legatees and devisees, known to the applicant, which list includes those persons entitled to administer the estate. The estimated value of the estate is: Personal Property Annual real property rentals Subtotal, personality and rentals Real Property Total estimated estate Applicant owes the estate The estate owes applicant [Check one of the following four paragraphs] Applicant says that decedent's Will requests that no bond be required, and therefore asks the Court to dispense with bond. Applicant is a trust company duly qualified in Ohio, and bond is dispensed with by law. FORM 4.0-APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE $_____________________ $_____________________ $_____________________ $_____________________ $_____________________ $_____________________ $_____________________ American LegalNet, Inc. www.FormsWorkFlow.com [Side 2 of FORM 4.0] CASE NO._____________________ Applicant is decedent's surviving spouse and is entitled to the entire net proceeds of the estate, or applicant is the next of kin entitled to the entire net proceeds of the estate and there is no will. Bond is dispensed with by law. Applicant offers the attached bond in the amount of $______________________________ Applicant accepts the duties of fiduciary in the estate imposed by law, and such additional duties as may be required by the Court. Applicant acknowledges being subject to removal as fiduciary for failure to perform such duties as required, and also acknowledges being subject to criminal penalties for improper conversion of any property held as fiduciary. __________________________________ Attorney for Applicant __________________________________ Typed or Printed Name __________________________________ Street Address __________________________________ City State Zip Code __________________________________ Phone Number (include area code) Attorney Registration No._____________ __________________________________ Applicant's Signature __________________________________ Applicant's Typed or Printed Name __________________________________ Street Address __________________________________ City State Zip Code __________________________________ Phone Number (include area code) WAIVER OF RIGHT TO ADMINISTER [R.C. 2113.06] The undersigned, being persons entitled to administer decedent's estate, and whose priority of right to do so is equal or superior to that of applicant, hereby waive appointment to administer the estate. _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets____________________________at__________o'clock____.M. as the date and time for the hearing the above application and orders notice to be given by the fiduciary, as provided in the Rules of Civil Procedure, to the wrongful death and survival claim beneficiaries who have not waived. __________________________________ Probate Judge American LegalNet, Inc. www.FormsWorkFlow.com