PROBATE COURT OF LUCAS COUNTY, OHIO JUDGE JACK R. PUFFENBERGER ESTATE OF ___________________________________________________________, DECEASED CASE NO. _________________________ *COMPUTATION OF ATTORNEY FEES (Decedent's Estate) 1. Probate Assets (including income of $_________________): ............................. $___________ _____ on the first $100,000.00 (______________________________) $___________ 4.5% 0.00 Enter up to $100,000.00 _____ on the next $300,000.00 (______________________________) $___________ 3.5% 0.00 Enter up to $300,000.00 Enter the balance _____ on the balance 2.5% 2. (______________________________) $___________ 0.00 Non-Probate assets includable in the Ohio Gross Estate: ......................................... $___________ _____ of the above ............................................................... $___________ 1.5% 0.00 Difference between non-probate assets includable in the Federal and Ohio Gross Estates: ..........................................$___________ _____ of the above ............................................................... $___________ 1.5% 0.00 TOTAL ATTORNEY FEE: ................................................... $ Less partial attorney fees previously allowed and taken pursuant to Court Order (see Local Rule 71.1(A)): 0.00 3. $ BALANCE OF ATTORNEY FEE:...........................................$___________ 0.00 _____________________________________ Date _____________________________________ Ohio Supreme Court ID # ____________________________________ Attorney's Signature ____________________________________ Attorney's Name (Print or Type) *Use this form if attorney's fees are being computed pursuant to Local Rule 71.1(F). Asset values for this schedule shall be the value includable in the Federal and Ohio Gross Estates. I, _______________________, Attorney-at-law, hereby certify, that the within instrument was prepared and/or examined by me, and that the same, in my opinion, is correct and proper. LUCAS COUNTY PROBATE FORM 13-C ­ COMPUTATION OF ATTORNEY FEES (MODIFIED) American LegalNet, Inc. www.FormsWorkFlow.com REV 5/13/08