PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF ___________________________________________________________, DECEASED CASE NO. ________________________ NEW CASE INFORMATION STATEMENT THE UNDERSIGNED CERTIFIES THAT THE WILLS ON DEPOSIT HAVE BEEN EXAMINED AND NO LATER WILL WAS FOUND ON DEPOSIT FOR THIS DECEDENT. WILL DEPOSITED IN THIS COURT ON __________________________ IS HEREBY WITHDRAWN AND ATTACHED HERETO. ________________________________ DEPUTY CLERK, PROBATE COURT ATTORNEY OF RECORD TO COMPLETE THE FOLLOWING SECTION THE UNDERSIGNED CERTIFIES THAT THIS CASE IS, IS NOT RELATED TO ANY CASE NOW PENDING IN ANY JUDICIAL SYSTEM. CASE NUMBER OF RELATED CASE __________________________ DESCRIPTION AND JURISDICTION OF RELATED CASE _______________________________________ PLEASE CHECK ONE OF THE FOLLOWING: ESTATE OR RELIEF FILED HEREWITH WILL ONLY TAX ONLY REAL ESTATE ONLY ESTATE OR RELIEF EXPECTED TO BE FILED ON OR BEFORE ___________________________________ OTHER _____________________________________________________________________________________ PLEASE CHECK ONE OF THE FOLLOWING REGARDING CITATION TO THE SURVIVING SPOUSE: DATE OF DEATH IS ON OR AFTER JANUARY 1, 2002, CITATION TO SURVIVING SPOUSE TO ISSUE FOR DATES OF DEATH PRIOR TO JANUARY 1, 2002 SPOUSE IS SOLE BENEFICIARY, CITATION IS UNNECESSARY SPOUSE IS NOT SOLE BENEFICIARY, PLEASE ISSUE A CITATION NO SURVIVING SPOUSE NO WILL FILED FOR PROBATE CITATION TO SPOUSE IS TO BE ISSUED AT REQUEST OF ATTORNEY OF RECORD STATEMENT OF PERMANENT ADDRESS The following address is my permanent address. I understand that I am required to notify the Court of any change in my address and that the Court is authorized to remove me if I fail to comply with this requirement. Signature, Attorney of Record Print Attorney Name Address ( ) Phone Number Ohio Supreme Court ID Number Signature, Applicant Print Name Address ( ) Phone Number FORM 1-A - NEW CASE INFORMATION STATEMENT REV. 01/2012 American LegalNet, Inc. www.FormsWorkFlow.com