PROBATE COURT OF SUMMIT COUNTY, OHIO ESTATE OF: ___________________________________________________________, DECEASED CASE NO. ________________________ NOTICE TO DISTRIBUTEE (R.C. 2113.533) TO DISTRIBUTEE: ________________________________ ________________________________ ________________________________ The undersigned fiduciary is making a distribution to you of assets from the estate prior to the deadline for filing claims against the estate. Distribution will be made after you sign, date, and return the Acknowledgment. You may be required to return the distribution, or you may be liable for repayment of the distribution, if a valid claim is later made against the estate within the time permitted under Section 2117.06 of the Revised Code. ____________________________________ Date __________________________________________ Applicant/Fiduciary __________________________________________ Type or Print Name __________________________________________ Address __________________________________________ City State Zip __________________________________________ Telephone Number (include area code) ACKNOWLEDGMENT I acknowledge that I have read the above Notice, and I understand that I may be required to return any or all of the distribution I receive if a valid claim is filed with the estate in the time allowed by law and the distribution I receive is needed to pay that claim. ________________________________________ Date ______________________________________________ Distributee Form 10.4A American LegalNet, Inc. www.USCourtForms.com