PROBATE COURT OF WOOD COUNTY, OHIO DAVID E. WOESSNER, JUDGE ESTATE OF _____________________________________________________________, DECEASED CASE NO. ______________________ REPRESENTATION OF INSOLVENCY AND REQUEST FOR HEARING 2117.15 Now comes ____________________________________________, _____________________________ of the Estate of _______________________________________________________, who died on ___________________________________________________, and sets forth the following facts: 1. _______________ months have passed since the undersigned was appointed as fiduciary (or commissioner) of the above captioned estate. 2. On __________________ an inventory (or schedule of assets to be relieved) was filed with this Court showing the following assets: Personal Property $ Real Property $ TOTAL ASSETS $ 0.00 The amount of total assets now differs from the amount set forth on the inventory (or schedule of assets to be relieved). The current amount of total assets is ___________________________. Explain the difference: 3. Attached hereto is a schedule of claims, showing all claims allowed and disallowed in the estate, the name and address of the claimants, the amount claimed, the payment class, and the date each claim was presented and allowed. Proposed payment to creditor is listed under the footnote column. TOTAL CLAIMS EQUAL $ 1 1.1 Representation of Insolvency and Request for Hearingu e s t f o r H e a r i n g American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. ______________________ 4. All references to payment class in the attached Schedule of Claims correspond to paragraph and numerical sub-section set forth in Ohio Revised Code § 2117.25. 5. All anticipated administrative costs have been estimated and listed as Class A (1) debts. Any family allowance due pursuant to Ohio Revised Code Section 2106.13 has been listed as a Class A (3) debt. 6. It appears that the estate is insolvent, and therefore the undersigned moves the Court to set a hearing on the matter to determine if the fiduciary acted properly in allowing and classifying each claim and to make an order confirming or disapproving such action. 7. Counsel for the fiduciary shall notify all creditors, claimants, and any other interested parties as the Court directs, of the hearing date and location by certified mail, return receipt requested. Proof of service, or waiver of same, and an AFFIDAVIT AS TO SERVICE shall be filed with the Court on or before the hearing date. Fiduciary Attorney (Signature) Attorney (Typed) Attorney’s Address Phone # 7-Digit Supreme Court I.D.# 1 1.1 Representation of Insolvency and Request for Hearing e q u e s t f o r H e a r i n g American LegalNet, Inc. www.FormsWorkFlow.com