PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF , DECEASED CASE NO. APPLICATION TO FILE DECEDENT222S WILL WITHOUT PROBATE Applicant states that decedent died on Decedent222s domicile was Street Address City or Village, or Township if unincorporated area County Post Office State Zip Code Applicant further states that a written instrument purporting to be the Last Will and Testament of the above-named Decedent is being filed with this application, for record only, and not for admission to probate. Applicant asks that said instrument and related papers be filed with the permanent record of this Court, and that further proceedings be suspended until further Court Order. Applicant Attorney for Applicant Typed or Printed Name Typed or Printed Name Address Address Phone Number (include area code) Phone Number (include area code) Supreme Court No. ENTRY FILING DECEDENT222S WILL WITHOUT PROBATE A written instrument purporting to be the Last Will and Testament of the above named Decedent has been filed for record with this Court. The Court finds that no application for admission to probate has been made and none need be filed. It is hereby ordered that said instrument and all papers relating thereto be filed, without probate, with the permanent files of this Court. It is further ordered that this proceeding be suspended until further Order of the Court. Date Judge Jack R. Puffenberger LUCAS COUNTY PROBATE COURT FORM 2-B 226 ENTRY FILING DECEDENT222S WILL WITHOUT PROBATE [ /1/2018] American LegalNet, Inc. www.FormsWorkFlow.com