IN THE PROBATE COURT OF MAHONING COUNTY, OHIO JUDGE MARK BELINKY IN THE MATTER OF THE DISINTERMENT OF:______________________________, DECEASED CASE NO.: _________________ AFFIDAVIT OF SERVICE [R.C. 517.24(B)(2)(c)(d)] The undersigned Applicant hereby states that all persons required to receive notice as provided in R.C. §517.24 (B)(2)(a) have either been notified that an application to disinter the Decedent’s remains has been filed, have waived notice, or their names or places of residence are unknown to the applicant and cannot with reasonable diligence be ascertained. Said waivers and/or evidence of notification are attached hereto, including copies of the return receipts for certified mail. The following persons did not receive notice:* ______________________________________ Name/Status _______________________________________ Reason ______________________________________ Name/Status _______________________________________ Reason ______________________________________ Name/Status _______________________________________ Reason __________________________________ Attorney Signature Applicant’s Signature _____________________________ Typed Name Typed Name _____________________________ Full Address (No P. O. Boxes) Full Address (No P. O. Boxes) _____________________________ City, State, Zip City, State, Zip _____________________________ Telephone (Include area code) Telephone (Include area code) Attorney Registration No. ________________ Dated: _________________________________ Sworn to and subscribed before me a notary public on this ________ day of ________________, 20______. (Seal) _____________________________________ Notary Public/Deputy Clerk (*Attach additional sheets, if necessary.) Revised 01-15-08 American LegalNet, Inc. www.FormsWorkflow.com