PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge Estate of:________________________________________________________________________, Deceased Case No:______________________ Date:__________________________ APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION [R.C. 2113.03] Applicant states that decedent died on_______________________________________. Decedent’s domicile was __________________________________________________________________________________________________ Street Address City or Village, or Township if unincorporated area __________________________________________________________________________________________________ County Post Office State Zip Code [Check one of the following] Decedent's will has been admitted to probate in this Court. To applicant's knowledge, decedent did not leave a will. [Check one of the following] The assets are $15,000 or less and decedent died on or after January 1, 1976. The assets are $25,000 or less and decedent died on or after October 20, 1987 The assets are $35,000 or less and decedent died on or after November 9, 1994. The assets are $50,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after April 16, 1993. The assets are $85,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or after September 14, 1993. The assets are $100,000 or less; the surviving spouse is entitled to all of the assets and the decedent Died on or after March 18, 1999 Applicant asks that the estate be relieved from administration because the assets do not exceed the statutory limits. A statement of the assets and liabilities of the estate is listed on the attached Form 5.1. The decedent's surviving spouse, next of kin, legatees and devisees known to applicant, are listed on the attached Form 1.0. Attorney for Applicant Applicant Typed or Printed Name Typed or Printed Name Address: Address: Phone Number (include area code) Phone Number (include area code) Attorney Registration Number FORM 5.0 - APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION 50 Crensch$\forms\5.0 7/26/01 American LegalNet, Inc. www.USCourtForms.com WAIVER OF NOTICE The undersigned surviving spouse, heirs at law, legatees, devisees, and other persons entitled to notice of the filing of the application to relieve decedent's estate from administration, waive such notice. American LegalNet, Inc. www.USCourtForms.com