IN THE PROBATE COURT OF MAHONING COUNTY, OHIO JUDGE MARK BELINKY IN THE MATTER OF THE DISINTERMENT OF:______________________________, DECEASED CASE NO.: _________________ APPLICATION TO DISINTER REMAINS OF A DECEDENT [R.C. 517.24] I, _______________________, the _______________________________, hereby make application (Describe relationship of applicant to the Decedent) for disinterment of the remains of the above named decedent now lying in _____________________ ____________________________ Cemetery, located at ___________________________________ _______________________, who died on the _______ day of ________________, (month), ________ (year), to be reinterred at _________________________________________________________________ The applicant represents to the Court that he/she is eighteen years of age or older and of sound mind; and that he/she did/ did not assume responsibility for the funeral and burial expenses of the decedent. A certified copy of the Decedent’s Death Certificate or other proof satisfactory to the Court is attached. Upon my Oath, first given, I say that the foregoing facts are true and correct. _____________________________________ 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 Revised 01-15-08 American LegalNet, Inc. www.FormsWorkflow.com