COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. PROBATE COURT OF LUCAS COUNTY, OHIO : Calendar No. JACK R. PUFFENBERGER, JUDGE Plaintiff(s) : JUDICIAL SUBPOENA IN THE MATTER-againstOF THE : DISINTERMENT OF: _______________________________________, DECEASED CASE NO. _________________________ : : Defendant(s) : ...................................................... APPLICATION FOR DISINTERMENT [R.C. §§ 517.23, 517.24] THE PEOPLE OF THE STATE OF NEW YORK The Applicant states that this Application is made pursuant to Chapter 517 of the Ohio Revised Code, to have the remains of the above named decedent disinterred by Court Order. The Decedent’s remains are currently located in _____________________ County, Ohio. Applicant further states that the following information is true: TO GREETINGS: 1. Applicant is an interested person of sound mind who is at least eighteen years old. 3. Applicant ‫ ٱ‬did ‫ ٱ‬did not assume the financial responsibility for funeral/burial expenses. If so, please attach a copy of the paid funeral bill, etc. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of Applicant’s relationship to decedent is _____________________________. 2. in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 4. Applicant states subpoena was issued for maximum penalty of $50 and religious sustained the party on whose behalf this that the disintermentais not against decedent’s all damages beliefs. as a result of your failure to comply. 5. Decedent’s remains will be re-interred at ____________________________ Witness, Honorable , one of the Justices of the Cemetery in _______________ County, State of __________________________. Court in Attached County, day listing the , 20 6. is a Form 1.0 of surviving spouse (if any) and all persons who would have been entitled to inherit from the decedent as next of kin under Revised Code Chapter 2105, as well as their complete addresses; if the decedent had a Last (Attorney must sign above and type name below) Will, Form 1.0 must list the surviving spouse (if any) and all legatees and devisees named in the Will as well as their addresses. 7. Attorney(s) for Notice will be given to all persons listed on Form 1.0 by certified mail as required by Chapter 517. Applicant will file an Affidavit of Service indicating proper service. If applicable, Applicant will file an Affidavit of Non-Notification Office and P.O. Address specifying any persons who were not given notice and the reasons for not giving notice. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 1 OF FORM LCPC – DIS300A «ejt411B5− American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : 8. 9. CASE NO. _________________________ Index No. Calendar No. Applicant states that decedent did not die of a contagious disease, or if so, a permit JUDICIAL SUBPOENA by the Board of Health pursuant to R.C. §§: 517.23 (B) is attached hereto. Plaintiff(s) -against- : Applicant swears that this information is true and asks that the matter be set for : hearing before this Court. : Defendant(s) : ...................................................... _________________________________ Attorney for Applicant _________________________________ THE PEOPLE OF THE STATE OF NEW YORK Typed or Printed Name TO _________________________________ Address _________________________________ _________________________________ Applicant _________________________________ Typed or Printed Name _________________________________ Address _________________________________ GREETINGS: _________________________________ _________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Phone Number (include area code) at the Phone Number (include area code) , the Honorable Court located at County of _________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed Ohio Supreme Court Number or adjourned date, to testify and give evidence as a witness in this action on the part of the Sworn tofailuresubscribed inthis subpoena is punishable as a _______________________ 20 ___. Your and to comply with my presence this day of contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _________________________________________ result of your failure to comply. Notary Public Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: PAGE 2 OF FORM LCPC – DIS300A American LegalNet, Inc. www.USCourtForms.com