PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF ________________________________________________________, DECEASED CASE NO. _________________________ REPORT OF DISTRIBUTION Now comes your duly appointed __________________________ herein and submits his report in said matter. Distribution of the assets has been made in accordance with the previous order of this Court in the following manner: DATE OF SALE OR DISTRIBUTION TO WHOM SOLD OR DISTRIBUTED DESCRIPTION PROCEEDS OR VALUE ________________________________________ Commissioner JUDGMENT ENTRY ________________________________, 20_____ The within report and distribution having been made according to law and the former Order of the Court, it is Ordered that the report and distribution are hereby approved. ________________________________________ Judge Jack R. Puffenberger 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. FORM 5.9 ­ REPORT OF DISTRIBUTION RELEASE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF ________________________________________________________, DECEASED CASE NO. _________________________ REPORT OF DISTRIBUTION Continuation Page Now comes your duly appointed __________________________ herein and submits his report in said matter. Distribution of the assets has been made in accordance with the previous order of this Court in the following manner: DATE OF SALE OR DISTRIBUTION TO WHOM SOLD OR DISTRIBUTED DESCRIPTION PROCEEDS OR VALUE Total from this Continuation Page _______________carried over to Page 1 FORM 5.9 ­ REPORT OF DISTRIBUTION RELEASE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE ESTATE OF ________________________________________________________, DECEASED CASE NO. _________________________ REPORT OF DISTRIBUTION Continuation Page Now comes your duly appointed __________________________ herein and submits his report in said matter. Distribution of the assets has been made in accordance with the previous order of this Court in the following manner: DATE OF SALE OR DISTRIBUTION TO WHOM SOLD OR DISTRIBUTED DESCRIPTION PROCEEDS OR VALUE Total from this Continuation Page _______________carried over to Page 1 FORM 5.9 ­ REPORT OF DISTRIBUTION RELEASE FROM ADMINISTRATION American LegalNet, Inc. www.FormsWorkFlow.com