PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF THE: TESTAMENTARY TRUST SPECIAL NEEDS TRUST WRONGFUL DEATH TRUST OTHER OF _________________________________________________________, DECEASED, GRANTOR CASE NO. _________________________ TRUSTEE'S ACCOUNT [R.C 2109.30] ________________________ Account From ______________ to ______________ Date 20 _____ (Balance from previous account or inventory) _____________________________________ Voucher No. Receipts $ Disbursements $ American LegalNet, Inc. www.FormsWorkFlow.com PAGE 1 OF TRUSTEE'S ACCOUNT - FORM LCPC TST 25.5A «utu36/6x- CASE NO. _________________________ TRUSTEE'S ACCOUNT CONTINUATION PAGE ________________________ Account From ______________ to ______________ Date Voucher No. Receipts $ Disbursements $ American LegalNet, Inc. www.FormsWorkFlow.com PAGE 2OF TRUSTEE'S ACCOUNT (CONTINUATION PAGE) - FORM LCPC TST 25.5A CASE NO. _________________________ RECAPITULATION Total Receipts Total Disbursements Balance Remaining in Trustee's Hands $ $ $ ITEMIZED STATEMENT OF ALL REMAINING FUNDS, ASSETS AND INVESTMENTS Item $ _______________________________________ Attorney _______________________________________ Supreme Court Registration No. _______________________________________ Trustee _______________________________________ Address _______________________________________ City, State, Zip Code Telephone Number (Include Area Code) ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets _________________________________________ at __________ o'clock ____m. as the date and time for hearing the above accounting and orders notice of the hearing to be given as provided by law and Rules of Civil Procedure. _____________________________ Date Judge Jack R. Puffenberger American LegalNet, Inc. www.FormsWorkFlow.com «FTIW- PAGE 3 OF TRUSTEE'S ACCOUNT - FORM LCPC TST 25.5A