PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE ESTATE OF CASE NO. , DECEASED APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION (SHORT FORM) Applicant says that decedent died on Decedent lived at Street Address . City County State Zip Code · · · · · Applicant asks that the estate be relieved from administration because the assets do not exceed Four Thousand Five Hundred Dollars ($4,500.00), and does not include real estate or stocks. Applicant states that the funeral bill is paid and is attached, no creditors will be prejudiced if there is no administration. Applicant states that the values given are accurate and readily ascertainable. Applicant says the decedent was survived by the people listed on the reverse side. Applicant, by signing this document, acknowledges receipt of the Order Relieving the Estate from Administration, and agrees to execute the Order of the Court within fifteen (15) days. Attorney Signature Attorney Typed or Print Name Address City/State/Zip Telephone Supreme Court Registration No. Applicant Signature Applicant Typed or Print Name Address City/State/Zip Telephone Relationship to Decedent Form ER.4 ­ APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION (Short Form) (Page 1 of 2) Rev. 05/29/2015 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. The following are decedent's known surviving spouse, children, and the lineal descendants of deceased children. If none, the following are decedent's next of kin who are or would be entitled to inherit under the statutes of descent and distribution. NAME RESIDENCE ADDRESS RELATIONSHIP TO DECEDENT BIRTH DATE OF MINOR The undersigned (including any person who paid the funeral bill but not an insurance company) verify and agree to the distribution set forth in the Court Order. Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Signature Type or Print Name Form ER.4 ­ APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION (Short Form) (Page 2 of 2) American LegalNet, Inc. www.FormsWorkFlow.com Rev. 05/29/2015