PROBATE COURT OF SHELBY COUNTY, OHIO , DECEASED ESTATE OF CASE NO. ______________________ MEMORANDUM The following is a list of all property, both real and personal, which passed as a gift or was transferred by the decedent prior to death, for which no adequate consideration was paid, including all joint and survivorship bank or stock deposits, certificates of stocks, bonds, or other securities standing in the name of the decedent, in accordance with provisions of Sections 5731.02 and 5731.04 of the Revised Code of Ohio. No. Item Signed this Description of Property day of Appraised Value , 20 ___ . Executor - Administrator American LegalNet, Inc. www.FormsWorkflow.com