TED KLAMMER, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO ESTATE OF ___________________________________________________________, DECEASED CASE NO. ______________________ CERTIFICATE OF TRANSFER NO._________ [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: __________________________________________________________________________________ Name Residence Transferee’s share Address 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. FORM 12.1-CERTIFICATE OF TRANSFER American LegalNet, Inc. www.FormsWorkFlow.com 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: ISSUANCE This Certificate of Transfer is issued this ______day of_________________________, ___________ __________________________________ Probate Judge CERTIFICATION I certify that this document is a true copy of the original Certificate of Transfer No.________issued on ________________________________and kept by me as custodian of the official records of this Court. ________________________________ Date ________________________________ Probate Judge By________________________________ Deputy Clerk Prepared by Attorney’s Name_______________________ Address______________________________ Phone No.____________________________ American LegalNet, Inc. www.FormsWorkFlow.com