PROBATE COURT OF WOOD COUNTY, OHIO DAVID E. WOESSNER, JUDGE * IN THE MATTER OF THE ESTATE OF: ______________________________ STATE OF OHIO COUNTY OF WOOD } } } * * * * * CASE NO. ______________________ AFFIDAVIT AS TO SERVICE (2117.17) SS ___________________________________________, being first duly sworn according to law, deposes and states that he/she personally served all the creditors named in the Schedule of Claims in the captioned case, together with a copy of the Notice of Hearing previously filed in this case. Attached hereto and made a part hereof, are the return receipt cards from all the creditors, which were signed and returned prior to the hearing scheduled for the determination of insolvency. Further affiant sayeth not. Signature of Affiant Printed Name of Affiant Sworn to before me and subscribed in my presence this ____ day of _______________, 20___. This document has been prepared by: Print Attorney Name Notary Public Signature, Attorney of Record Nottary Seall No ary Sea Address of Attorney Phone Number Ohio Supreme Court Number 1 1.4 Affidavit as to Servicee r v i c e American LegalNet, Inc. www.FormsWorkFlow.com