Lorain County Probate Court Judge James T. Walther 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. 12.1 - CERTIFICATE OF TRANSFER 10/1/98 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 _______________________________________, 20____. ____________________________________________________ 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 ___________________________________________________ Judge By ________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com