PROBATE COURT OF SHELBY COUNTY, OHIO CONSERVATORSHIP OF CASE NO. CONSERVATOR'S ACCOUNT (R.C. 2109.30) Account From To Date (Balance from previous account) Voucher No. $ $ American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 H. C. FORM 20.8 - CONSERVATOR'S ACCOUNT 02/10/03 CASE NO. RECAPITULATION Total Receipts Total Disbursements Balance Remaining $ $ $ ITEMIZED STATEMENT OF ALL FUNDS, ASSETS AND INVESTMENTS ITEM $ Attorney Attorney Registration No. Conservator Typed or Printed Name Address of Conservator BANK CERTIFICATE N.B. Must be executed when funds are on deposit. I HEREBY CERTIFY that the within named fiduciary, on the date named below, had on deposit in The of , Ohio, the sum of $ to the credit of the estate of Nature of Deposit on Bank By Dated Page 2 of 2 Cashier H.C. FORM 20.8 - CONSERVATOR'S ACCOUNT American LegalNet, Inc. www.FormsWorkFlow.com