PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF: CASE NO.: JOURNAL ENT RY Now comes the Court, upon consideration of the Motion to Proceed in Forma Pauperis (and the supporting affidavit), and finds same to be ( well or  not well) taken, and hereby ( grants or ( denies) same. Therefore, it is ordered, adjudged, and decreed that the petitioner ( is or  is not) permitted to proceed without a deposit of costs herein. Further, costs to be assessed by Lucas County Probate Court, with the exception of Newspaper Publication, Foreign Sheriff Service, or other actual expenses, which Probate Court may incur, are hereby ( waived or  delayed until funds become available). Judge Jack R. Puffenberger Lucas County Probate Court Date 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. D.41- LUCAS COUNTY PROBATE COURT FORM C-3 MODIFIED JOURNAL ENTRY EFF: 6/05 American LegalNet, Inc.American LegalNet, Inc. www.USCourtForms.comwww.USCourtForms.com