TED KLAMMER, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO IN RE ___________________________________________________________________________ CASE NO. _______________________ APPLICATION FOR DISINTERMENT The undersigned hereby request an Order from the Lake County Probate Court authorizing the disinterment of ______________________________________and in support of said application says as follows: 1. Applicant _____________________________________(did or did not) assume financial responsibility for the funeral and burial expenses of the decedent. 2. Applicant is at least 18 years of age and of sound mind. 3. Applicant is the_________________________________(state relationship) of the decedent. 4. A statement of the applicant’s reasons for the disinterment of the remains of the decedent._____________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Applicant says that the remains of the decedent will be reinterred at (name and address of cemetery or other facility)._______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. The decedent_____________________________________(did or did not) have a surviving spouse. 7. Name of surviving spouse:_______________________________________________________ 8. Address of surviving spouse:_____________________________________________________ ____________________________________________________________________________ 9. The decedent_____________________________________(did or did not) have a will. 1 American LegalNet, Inc. www.FormsWorkFlow.com 10. If the decedent had a will, state the name, address and relationship of all beneficiaries named in the will. (Attach additional sheet if necessary.) ____________________________________________________________________________ Name Address Relationship to Decedent ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 11. If the decedent did not have a will, state the name, address and relationship of the statutory heirs of the decedent. (Attach additional sheet if necessary.) ____________________________________________________________________________ Name Address Relationship to Decedent ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com 12. All persons entitled to notice of the filing of this application________________(have or have not) signed Waivers of Notice pursuant to Section 517.24(B)(2)(b) of the Ohio Revised Code, which are attached hereto, and an hearing therefore_______________(is or is not) required. ________________________________________ Applicant ________________________________________ Typed or printed name ________________________________________ Address ________________________________________ ________________________________________ Telephone number STATE OF OHIO ) ) COUNTY OF LAKE ) SS I, _______________________________________,(name of Applicant), being first duly sworn, depose and say that the statements are forth above are true and correct to the best of my knowledge, information and belief. FURTHER AFFIANT SAYETY NAUGHT ________________________________________ Applicant Sworn to before me and subscribed in my presence this______________________day of __________________________, 20_______. ________________________________________ Notary Public 3 American LegalNet, Inc. www.FormsWorkFlow.com