Lorain County Probate Court Judge James T. Walther ESTATE OF __________________________________________________________________, DECEASED CASE NO. ________________________ FIDUCIARY'S ACCOUNT [R.C. 2109.30, 2109.301 and 2109.32] [Executors and Administrators] The fiduciary offers the account given below and on the attached itemized statement of receipts and disbursements. The fiduciary states that the account is correct, and asks that it be approved and settled. [Check one of the following] This is a partial account. A statement of the assets remaining in the fiduciary's hands is attached. This is a final account. A statement of the assets remaining in the fiduciary's hands for distribution to the beneficiaries is attached. This is an account of distribution, and fiduciary asks to be discharged upon its approval and settlement. This is a final and distributive account, and the fiduciary asks to be discharged upon its approval and settlement. This is a supplemental final account. [Complete if this is a partial account, or if one or more accounts have previously been filed in the estate] The period of this account is from _______________________________________________ to ___________________________________________________ [Complete if applicable] Accounts previously filed in the estate, the accounting periods, and the fiduciary and attorney fees paid for each period, are as follows: ____________________________________________________________________________________________________________ Date Filed Accounting Period Fiduciary Attorney Fees Paid Fees Paid $ $ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Note: 2117.06(K) states: “The distributee may be liable to the estate up to the value of the distribution and may be required to return all or any part of the value of the distribution if a valid claim is subsequently made against the estate within the time permitted under this section.” 2109.32(C) states: “The rights of any person with a pecuniary interest in the estate are not barred by approval of an account pursuant to division (A) and (B) of this section. These rights may be barred following a hearing on the account pursuant to section 2109.33 of the Revised Code.” 13.0 - FIDUCIARY'S ACCOUNT 12/01/2002 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ______________________ This account is recapitulated as follows: RECEIPTS Personal property not sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_______________________ Proceeds from sale of personal property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ Real property not sold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ Proceeds from sale of real property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________ Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ Other receipts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________ Total receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_____________________ DISBURSEMENTS Fiduciary fees this accounting period . . . . . . . . . . . . . . . . . . . $____________________ Attorney fees this accounting period . . . . . . . . . . . . . . . . . . . _____________________ Other administration costs and expenses. . . . . . . . . . . . . . . . . _____________________ Debts and claims against estate . . . . . . . . . . . . . . . . . . . . . . . . _____________________ Ohio and federal estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________ Personal property distributed in kind . . . . . . . . . . . . . . . . . . . . _____________________ Real property transferred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________ Other distributions to beneficiaries . . . . . . . . . . . . . . . . . . . . . _____________________ Other disbursements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________ Total disbursements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________ BALANCE REMAINING IN FIDUCIARY'S HANDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________________ __________________________________________ Attorney ___________________________________________________ Fiduciary Attorney Registration No. _____________________ Date__________________________________________________ ENTRY SETTING HEARING The Court sets ______________________________________ at ________________ o'clock _____ M., as the date and time for hearing the above account. Date_________________________________________ Judge____________________________________ American LegalNet, Inc. www.FormsWorkFlow.com