Prob. 5.0 A COUNTY, OHIO COMMON PLEAS COURT, PROBATE DIVISION, , Deceased. In the matter of the Estate of: Case No. _____________________________ APPLICATION FOR SHORT FORM RELEASE OF ADMINISTRATION (O.R.C. 2113.03) , who resides at Now comes , who having been first duly sworn, states: 1. Applicant’s relationship to decedent is ; 2. Decedent’s legal residence at time of death ; 3. Decedent’s date of death ; 4. Decedent (did) (did not) have a will; 5. Attached is a list of surviving spouse, next of kin, legatees and devisees known to affiant, entitled to inherit (1.0); 6. Decedent’s assets consist of the following (Assets and probable value) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________; 7. That applicant has paid from his own assets, will assume the responsibility of paying from decedent’s assets, or has provided the funeral and burial expenses and services; 8. Decedent’s funeral and burial expenses were as follows: Itemize: ____________________________________________________________________________________ ____________________________________________________________________________________; 9. Applicant requests the Court to enter an order directing and authorizing applicant to collect the assets and distribute them as directed by the Court; 10. That applicant will distribute within 30 days all assets of decedent covered by the order as directed by the Court and receipt therefor to the Court. Applicant Sworn to before me and signed in my presence, this 20_____. day of . Notary Public American LegalNet, Inc. www.FormsWorkflow.com COMMON PLEAS COURT, PROBATE DIVISION, COUNTY, OHIO , Deceased. In the matter of the Estate of: Case No. _____________________________ ORDER (O.R.C. 2113.03) The matter came on for hearing on an application filed in this cause in conformance with O.R.C. 2113.03 and the Court finds from the application that a short form Release from Administration is applicable in this estate. WHEREFORE, IT IS THE ORDER OF THIS COURT that: ___ the estate be relieved from administration; ___ the financial institution holding accounts in decedent=s name, pay the same to , the applicant herein and that said applicant gather such other assets as are listed in said application; ___ said applicant shall apply the assets first in the payment of or reimbursement for the cost in filing this proceeding to , secondly in payment of or reimbursement for the burial expenses in the amount of $ to __________________ in that order; ___ said applicant shall apply the remaining assets in the payment of the family allowance in the amount of $ ___ to ; the Court further orders: __________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. _____________________________________________ Judge American LegalNet, Inc. www.FormsWorkflow.com