MARK J. BARTOLOTTA, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO ESTATE OF ___________________________________________________________, DECEASED CASE NO. ______________________DOCKET________________________PAGE____________ SUPPLEMENTAL APPLICATION FOR ANCILLARY ADMINISTRATION Revised Code, Sec. 2129.04 Applicant says that the decedent named in the attached application for authority to administer the estate died [check one of the following] owning property in this county having a debtor residing in this county Applicant is a resident of Ohio. [Check one of the following three paragraphs] Applicant is the general executor named in decedent's Will, and is duly appointed, qualified and acting in that capacity in the state of_____________________. An exemplified record of the grant of his letters of authority is attached. Applicant is named in decedent's Will as executor of his Ohio estate. Applicant is a resident of this county. Decedent either died intestate, or did not designate an Ohio executor or administrator in his will. [Check if applicable] An authenticated copy of decedent's Will, duly proved in another state, is attached and offered for record. The estimated value of decedent's Ohio estate is $___________________. __________________________________ Applicant FORM 4.1-SUPPLEMENTAL APPLICATION FOR ANCILLARY ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com