PROBATE COURT OF SHELBY COUNTY, OHIO WILLIAM R. ZIMMERMAN, JUDGE ESTATE OF , DECEASED CASE NO. APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE [R.C. 2109.02 and 2109.07] [For Executors and all Administrators; attach supplemental application for ancillary administration, if applicable] Applicant states that decedent died on Decedent's domicile was Street Address City or Village, or Township if unincorporated area Post Office County State Zip Code Applicant asks to be appointed of decedent's estate- [Check whichever of the following are applicable] To applicant's knowledge, decedent Decedent's Will has been admitted to probate in this Court did not leave a Will A supplemental application for ancillary administration is attached. Attached is a list of the surviving spouse, children, next of kin, legatees and devisees, known to applicant, which list includes those persons entitled to administer the estate. The estimated value of the estate is: Personal property $ Annual real property rentals $ Subtotal, personalty and rentals $ Real Property $ Total estimated estate $ Applicant owes the estate $ The estate owes applicant $ [Check one of the following four paragraphs] Applicant says that decedent's Will requests that no bond be required of, and therefore asks the Court to dispense with bond. Applicant is a trust company duly qualified in Ohio, and bond is dispensed with by law. Page 1 of 2 H.C. FORM 4.0 - APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE 12/01/02 American LegalNet, Inc. www.FormsWorkflow.com CASE NO. Applicant is decedent's surviving spouse and is entitled to the entire net proceeds of the estate, or applicant is the next of kin entitled to the entire net proceeds of the estate and there is no will. Bond is dispensed with by law. Applicant offers the attached bond in the amount of $ Applicant accepts the duties of fiduciary in the estate imposed by law, and such additional duties as may be required by the Court. Applicant acknowledges being subject to removal as fiduciary for failure to perform such duties as required, and also acknowledges being subject to criminal penalties for improper conversion of any property held as fiduciary. Attorney for Applicant Applicant Typed or Printed Name Typed or Printed Name Address Address Phone Number (include area code) Phone Number (include area code) Attorney Registration No. WAIVER OF RIGHT TO ADMINISTER [R.C. 2113.06] The undersigned, being persons entitled to administer decedent's estate, and whose priority of right to do so is equal or superior to that of applicant, hereby waive appointment to administer the estate. Page 2 of 2 H.C. FORM 4.0 - APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE American LegalNet, Inc. www.FormsWorkflow.com