PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE ESTATE OF _______________________________________________________, DECEASED CASE NO.______________________________ CONTINUATION OF INSOLVENCY SCHEDULE OF CLAIMS [R.C. 2117.15, 2117.17, 2117.25] Page ____ of ____ Pages [Note: Include a subtotal following each payment class and a grand total for all payment classes.] ____________________________________________________________________________________________________________________ Name and Address Payment Amount Estimated Claim of Claimant Class Claimed Payment Rejected: Y/N _______________________________________________________________________________________________________ 1. (1) Comments (Refer to Claim Number) ________________________________________________________________________ _______________________________________________________________________________________________________ _____________________________________________________ Fiduciary FORM 24.5 – CONTINUATION SCHEDULE OF CLAIMS Effective Date: January 1, 2012 American LegalNet, Inc. www.FormsWorkFlow.com