PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge ESTATE OF:____________________________________________________________________, Deceased Case No.________________________________ Date__________________________ NOTICE TO DISTRIBUTEE [R.C. 2113.533] TO: _ _ 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 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. Fiduciary Typed or Printed Name Address Phone Number (include area code) Date 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 Distriributee Form 10.4A - NOTICE TO DISTRIBUTEE FOR PERSONS DECEASED ON OR AFTER MAY 31, 1990 Crensch$\forms\10.4A *10.4a* 7/26/01 American LegalNet, Inc. www.USCourtForms.com