PROBATE COURT OF SHELBY COUNTY, OHIO WILLIAM R. ZIMMERMAN, JUDGE ESTATE OF , DECEASED CASE NO. APPLICATION TO PROBATE WILL [R.C. 2107.11, 2107.18, and 2107.19] 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 A document purporting to be decedent's last will is attached and offered for probate, and applicant waives notice of probate of this will. Decedent's surviving spouse, children, next of kin, legatees and devisees, known to applicant, are listed on the attached Form 1.0. 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 NOTICE OF PROBATE OF WILL The undersigned, being persons entitled to notice of the probate of this will, waive such notice. After a certificate is filed evidencing these waivers and any notices given, any action to contest the validity of this will must be filed no more than three months after the filing of the certificate for estates of decedents who die on or after January 1, 2002, and no more than four months after the filing of the certificate for estates of decedents who die before January 1, 2002. H.C. FORM 2.0 - APPLICATION TO PROBATE WILL 12/01/02 American LegalNet, Inc. www.FormsWorkflow.com