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MARK J. BARTOLOTTA, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO ESTATE OF ___________________________________________________________, DECEASED CASE NO. ______________________ WAIVER AND CONSENT WRONGFUL DEATH AND SURVIVAL CLAIMS The undersigned waive notice of the hearing and consent to and approve the settlement and distribution as set forth in Form 14.0 Application to Approve Settlement and Distribution of Wrongful Death and Survival Claims, a copy of which I have received. _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Print Reset FORM 14.1-WAIVER AND CONSENT WRONGFUL DEATH AND SURVIVAL CLAIMS American LegalNet, Inc. www.FormsWorkFlow.com
