PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE ESTATE OF CASE NO. , DECEASED APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE [R.C. 2109.02 and 2109.07] [For Executors and all Administrators; attach supplemental application for ancillary administration, if applicable] Applicant says that decedent died on Decedent's domicile was Street Address County State Zip Code City, or Village, or Township (if unincorporated area) Post Office Applicant asks to be appointed [Check whichever of the following is applicable] of decedent's estate. To applicant's knowledge, decedent did not leave a Will. Decedent's Will has been admitted to probate in this Court. A supplemental application for ancillary administration is attached. Attached is a list of the surviving spouse, children, next of kin, and legatees and devisees known to applicant, which list includes those persons entitled to administer the estate. The estimate value of the estate is: Personal Property .................................................................................................................................................. $ Annual real property rentals ...........................................................................................................................$ Subtotal, personal and rentals ...................................................................................................................... $ Real Property ........................................................................................................................................................... $ Total estimated estate ........................................................................................................................................ $ Applicant owes the estate ................................................................................................................................. $ The estate owes applicant ............................................................................................................................... $ [Check whichever of the following is applicable] Applicant says that decedent's Will requests that no bond be required, and therefore asks the Court to dispense with bond. Applicant is a trust company duly qualified in Ohio, and bond is dispensed with by law. Applicant is decedent's surviving spouse, and is entitled to the entire net proceeds of the estate, or is the next of kin entitled to the entire net proceeds of the estate and there is no will, therefore bond is dispensed with by law. Applicant offers the attached bond in the amount of $ . Decedent was fifty-five (55) years of age or older at the time of death and was a recipient of medical assistance under Chapter 5111 of the Revised Code. Form 7.0 - Notice of Administrator of Estate Recovery Program has been or will be filed. FORM 4.0 ­ APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE (Page 1 of 2) Rev. 11/03/2014 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. Applicant accepts the duties of the fiduciary in the estate, imposed by law, and such additional duties as may be required by the Court. Applicant acknowledges being subject to removal as fiduciary for failure to perform such duties as required, and also acknowledges being subject to criminal penalties for improper conversion of any property held as fiduciary. Attorney for Applicant's Signature Attorney for Applicant's Typed or Printed Name Address City State Zip Applicant's Signature Applicant's Typed or Printed Name Address City State Zip Telephone Number (include area code) Telephone Number (include area code) Attorney Registration No. WAIVER OF RIGHT TO ADMINISTER [R.C. 2113.06] The undersigned, being persons entitled to administer decedent's estate, and whose priority of right to do so is equal or superior to that of applicant, hereby waive appointment to administer the estate. ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets at o'clock .M. as the date and time for hearing the application for authority to administer decedent's estate. The Court orders notice to take or renounce administration to be given those persons entitled to administer decedent's estate, whose priority of right to do so is equal or superior to that of applicant, and who have not waived appointment to administer the estate. IT IS SO ORDERED. Date JUDGE ELINORE MARSH STORMER FORM 4.0 ­ APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE (Page 2 of 2) Rev. 11/03/2014 American LegalNet, Inc. www.FormsWorkFlow.com