PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE ESTATE OF CASE NO. , DECEASED CERTIFICATE OF TRANSFER NO. [Check one of the following] Decedent died intestate. Decedent died testate. Decedent died on ______________________________________________ owning the real property described in this certificate. The persons to whom such real property passed by devise, descent or election are as follows: Name Residence Address Transferee's share of decedent's interest [Complete if applicable] The real property described in this certificate is subject to a charge of $ in favor of decedent's surviving spouse, in respect of the unpaid balance of the specific monetary share which is part of the surviving spouse's total intestate share. FORM 12.1 ­ CERTIFICATE OF TRANSFER (Page 1 of 2) Rev. 03/01/2014 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. The legal description of decedent's interest in the real property subject to this certificate is: [use extra sheets, if necessary]. Prior Instrument Reference: Parcel No: This instrument was prepared by ISSUANCE This Certificate of Transfer is issued this day of , 20 . JUDGE ELINORE MARSH STORMER AUTHENTICATION I certify that this document is a true copy of the original Certificate of Transfer No. issued on and kept by me as custodian of the official records of this Court. Date JUDGE ELINORE MARSH STORMER By Deputy Clerk FORM 12.1 ­ CERTIFICATE OF TRANSFER (Page 2 of 2) Rev. 03/01/2014 American LegalNet, Inc. www.FormsWorkFlow.com