PROB 40-V PROBATE COURT OF SHELBY COUNTY, OHIO , DECEASED ESTATE OF CASE NO. ___________________________ AFFIDAVIT TO TRANSFER TITLE OF AUTOMOBILE Affidavit (Sec. 4505.10) The undersigned, being duly sworn, says that decedent, who died on the day of he is the surviving spouse of the above named , 20 ; that said decedent owned the automobile described below; that said automobile has an approximate value of ; that said automobile is not otherwise disposed of by will; and the affiant is entitled to said vehicle pursuant to O.R.C. 4505.10. Year: Manufacturer's Serial No.: Make: Body Type: Model: Ohio Certificate of Title No.: __________________________________________ Surviving Spouse 20 . Sworn to before me and subscribed in my presence this day of __________________, _________________________________________ Notary Public CERTIFICATION State of Ohio, Shelby County, SS: I, taken and copied from the original affidavit filed on the as the same appears of record and on file in said court. Witness my hand and the seal of this Court this day of , 20 . , hereby certify that the above and foregoing is truly day of , 20 , _________________________________________ Probate Judge _________________________________________ By: Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com