Report Of Distribution Of Wrongful Death And Survival Claims
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Report Of Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be use in Shelby County (Court Of Common Pleas).
Loading PDF...
Tags: Report Of Distribution Of Wrongful Death And Survival Claims, 14.3, Ohio County (Court Of Common Pleas), Shelby
PROBATE COURT OF SHELBY COUNTY, OHIO
WILLIAM R. ZIMMERMAN, JUDGE
, DECEASED
ESTATE OF
CASE NO.
REPORT OF DISTRIBUTION OF
WRONGFUL DEATH AND SURVIVAL CLAIMS
Pursuant to Entry filed
,
, the proceeds have been paid as
shown below and on the accompanying vouchers.
Gross proceeds
$
Funeral and burial expenses
$
Fiduciary fees to
$
Reimbursement of case expenses to
$
Attorney fees to
$
Survival claim to the estate
$
Total deductions
$
Net proceeds
$
Net proceeds to beneficiaries.
To:
$
To:
$
To:
$
To:
$
To:
$
To:
$
To:
$
Total payments to beneficiaries
$
Balance
-0-
The fiduciary states that there are no other assets remaining in the estate.
The fiduciary states that there are assets remaining in the estate.
Attorney for Fiduciary
Fiduciary
Attorney Registration No.
H.C. FORM 14.3 - REPORT OF DISTRIBUTION OF WRONGFUL DEATH AND SURVIVAL CLAIMS
04/01/97
American LegalNet, Inc.
www.FormsWorkflow.com
