Report Due__________ Proof of distribution Required with filing of Report. PROBATE COURT OF LAKE COUNTY, OHIO MARK J. BARTOLOTTA, JUDGE ESTATE OF_____________________________________________________________________, DECEASED Case No.___________________________ Docket ____________________________ Page__________________ REPORT OF DISTRIBUTION Now comes your duly appointed ______________________ herein and submits his Report in said matter. Distribution of the assets has been made in accordance with the previous order of this Court in the following manner: Date of Sale or Distribution To Whom Sold or Distributed Description Proceeds or Value _____________________________ Fiduciary JUDGMENT ENTRY The within report and distribution having been made according to law and the former order of the Court, it is ordered that the report and distribution are hereby approved. Prepared by Attorney's name____________________ Address__________________________ Phone No.________________________ _____________________________ Judge FORM 5.9 REPORT OF DISTRIBUTION-RELEASE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com