PROBATE COURT OF LAKE COUNTY, OHIO MARK J. BARTOLOTTA, JUDGE ESTATE OF ______________________________________, DECEASED CASE NO. ____________________ CERTIFICATE OF TERMINATION [R.C. 2109.30] I certify I am the executor or administrator and the sole legatee, devisee or heir. I further certify: (1) all debts and claims presented to the estate have been paid in full or settle finally; (2) an estate tax return, if required under Chapter 5731 of the Revised Code, has been filed, and any estate tax due under that chapter has been paid; (3) all attorney fees have been [check one] waived by counsel of record, paid to counsel of record in the amount of $___________________; (4) all fiduciary fees have been [check one] waived by the fiduciary; paid to the fiduciary in the amount of $_____________________; (5) all assets remaining after completion of the activities described above have been distribution to myself as the sole legatee, devisee or hair. ________________________________ Attorney for Fiduciary Attorney Registration No. __________ ________________________________ Fiduciary ENTRY Based upon the above certification it is ordered that the fiduciary and surety, if any, are discharged. Prepared by: Attorney's Name__________________________________ Address _________________________________________ _______________________________________________ Phone No. _______________________________________ ______________________________ Probate Judge FORM 13.6 ­ CERTIFICATE OF TERMINATION American LegalNet, Inc. www.FormsWorkFlow.com