PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE ESTATE OF , DECEASED CASE NO. FIDUCIARYS BOND [For Executors and all Administrators] Amount of Bond $ The undersigned principal, and sureties if any, are obligated to the Sta te of Ohio in the above amount, for payment of which we bind ourselves and our successors, heirs , executors, and administrators, jointly and severally. The principal has accepted in writing the duties of fiduciary in deceden ts estate, including those imposed by law and such additional duties as may be required by th e Court. This obligation is void if the principal performs such duties as require d. This obligation remains in force if the principal fails to perform such duties, or performs them tardily, negligently, or improperly, or if the principal misuses or misa ppropriates estate assets or improperly converts them to his own use or the use of another. [Check if personal sureties are involved.] The sureties certify that each of them owns real estate in this county, with a reasonable net value as stated below. Date Principal Surety Surety by by Attorney in Fact Attorney in Fact Typed or Printed Name Typed or Printed Name Address Address Net value of real estate owned in this county Net value of real estate owned in this county $ $ FORM 4.2 - FIDUCIARYS BOND 07/01/77 American LegalNet, Inc. www.USCourtForms.com