PROBATE COURT OF SHELBY COUNTY, OHIO TRUST OF FOR THE BENEFIT OF CASE NO. APPLICATION FOR THE APPOINTMENT OF A TRUSTEE Now comes , a resident of Shelby County, Ohio, and hereby makes application to be appointed Trustee of said Estate and agrees to perform the duties of said office according to [Check one]: the terms of said Will (and Codicil/s) under Item the wrongful death trust; , for the benefit of special needs trust; other (specify) . Your applicant represents that said trust estate is estimated as follows: Personal Property $ Real Property $ Annual Rents $ Other Annual Income $ Wherefore your applicant asks to be appointed Trustee and presents a bond as such Trustee in the with the following surety: sum of $ Applicant accepts the duties of Trustee imposed by law, and such additional duties as may be required by the Court. Applicant acknowledges that he/she may be removed as fiduciary for failure to perform such duties as required, and also acknowledges that he/she may be subject to criminal penalties for improper conversion of any property held has fiduciary. Attorney for Applicant Typed or Printed Name Address City State Zip Code Applicant Typed or Printed Name Address City State Zip Code Phone No. (include area code) Attorney Registration No. Phone No. (include area code) American LegalNet, Inc. www.FormsWorkFlow.com H.C. FORM 24.1 - APPLICATION FOR APPOINTMENT OF A TRUSTEE 02/10/03