PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge IN THE MATTER OF:_______________________________________________________________________ Case No._______________________ Date__________________________ CERTIFICATE OF TERMINATION [R.C. 2109.301] I certify I am the executor or administrator and the sole legatee, devisee or heir. I further certify: (1) all debts and claims presented to the estate have been paid in full or settled finally; (2) an estate tax return, if required under Chapter 5731 of the Revised Code, has been filed, and any estate tax due under that chapter has been paid; (3) all attorney fees have been [check one] waived by counsel of record, paid to counsel of record in the amount of $ (4) ; all fiduciary fees have been [check one] waived by the fiduciary; paid to the fiduciary in the amount of $ (5) ; all assets remaining after completion of the activities described above have been distributed to myself as the sole legatee, devisee or heir. Attorney for Fiduciary Fiduciary Attorney Registration Number ENTRY Based upon the above certification it is ordered that the fiduciary and surety, if any, are discharged. Date Journalized David E. Woessner, Probate Judge FORM 13.6 - CERTIFICATE OF TERMINATION Crensch$\forms\13.6 136 12/4/01 American LegalNet, Inc. www.USCourtForms.com