PROBATE COURT OF SHELBY COUNTY, OHIO TRUST OF FOR THE BENEFIT OF CASE NO. TRUSTEE'S ACCOUNT [R.C. 2109.30] The trustee offers an account of the trust and has attached an itemized statement of receipts and disbursements. The trustee states that the account is true and correct, and asks that it be approved and settled. [Check one of the following] This is the (Number) to . A statement of the assets remaining in the trustee's hands is attached. partial account for the period from This is a final and distributive account, and the trustee asks to be discharged upon its approval and settlement. This account is recapitulated as follows: RECEIPTS Balance brought forward from inventory or previous account Income Other receipts Total receipts DISBURSEMENTS Fiduciary fees (this accounting period) Attorney fees (this accounting period) Other administration costs and expenses Other disbursements Total disbursements BALANCE REMAINING IN FIDUCIARY'S HANDS $ $ $ $ .$ $ $ $ $ $ Date Page 1 of 2 Trustee H.C. FORM 24.8 - TRUSTEE'S ACCOUNT American LegalNet, Inc. www.FormsWorkFlow.com 02/10/03 CASE NO. BANK CERTIFICATE N.B. Must be executed when funds are on deposit. I HEREBY CERTIFY that the within names trustee, on the date named below, had on deposit in the of $ on Nature of Deposit of , Ohio the sum to the credit of the trust of Bank Dated By Cashier Trustee BANK CERTIFICATE N.B. Must be executed when funds are on deposit I HEREBY CERTIFY that the within named trustee, on the date named below, had on deposit in the the sum of $ on Nature of Deposit of , Ohio to the credit of the trust of Bank Dated By Cashier Trustee American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 H.C. FORM 24.8 - TRUSTEE'S ACCOUNT