PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE 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 Address Transferee's share 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 Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com (Reverse of Form 12.1) CASE NO._____________________ 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: This instrument was prepared by _________________________________________________________ ISSUANCE This Certificate of Transfer is issued this ______ day of _______________________________, 20____. Judge Jack R. Puffenberger AUTHENTICATION 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 By Judge Jack R. Puffenberger Deputy Clerk 12.1 ­ CERTIFICATE OF TRANSFEER PAGE 2 Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com Print Reset